By Michael Solis, Trócaire Programme Manager, Sierra Leone

Nineteen months since the onset of the world’s worst Ebola outbreak in West Africa, Sierra Leone has been declared free of the disease.

This was after a period of 42 days — the length of two Ebola incubation cycles — had passed since the last person confirmed to have Ebola was cleared.

You can help support families affected by Ebola by buying the Gift of Seeds and Tools for Sierra Leone this Christmas: www.trocaire.org/gifts/seeds-tools

To celebrate the occasion, Trócaire organised an event with its 18 partners who have been vital to the Ebola response. The event was a moment of unity amongst partners and acknowledgment of shared achievements. Partners expressed their gratitude to Trócaire for its support and for enabling them to respond to the disease.

“Trócaire was so important because they did exactly what the people needed,” said Sister Mary Sweeney from St. Joseph’s School for the Hearing Impaired. “People needed things like blankets, mattresses, and food, and Trócaire was there to respond.”

“We thank Trócaire for staying in Sierra Leone when so many organizations were leaving the country,” said Susie Turay, from Access to Justice Law Centre. “Trócaire brought us all together and asked us what it is we could do to respond. When we came up with ideas, like offering psychosocial support in the communities,Trócaire provided us with training to make them happen.”

“Trócaire helped us design a model for developing the livelihoods of quarantined families,” said Ibrahim Fatu Kamara, Director of Action for Advocacy and Development (AAD). “We were then able to replicate that work in other parts of the country.”

Together with its partners, Trócaire helped support 1,750 quarantined households with food and non-food items, provided replacement packages to 720 decontaminated households, offered livelihoods support to 900 families, brought psychosocial support to over 10,000 people, and carried out awareness raising activities across three Districts to prevent risky behaviours that could promote continued transmission.

While a wave of joy and relief has spread throughout Sierra Leone, people still continue to sanitize their hands before entering buildings, and many still hesitate before embracing or shaking other people’s hands, which is now allowed. The population was willing to sacrifice a lot as long as it meant getting the virus out of the country, and now that the darkest days appear to be over, no one wants Ebola to return.

In Sierra Leone, Ebola infected 8,704 people and claimed 3,589 lives. Approximately 4,000 people survived.

Some estimates of the number of orphans (children who lost one or both parents to Ebola) reach up to 12,000 (Source: Street Child), with the average age of orphans being 9 years old.

Over 7,300 people have lost their lives to Ebola in Liberia and Guinea, the other West African nations affected by the epidemic. While Liberia was declared Ebola-free in September, Guinea, where the epidemic began, continues to see new cases. A reported lack of cooperation amongst the population in Guinea with restrictions on handshaking and consulting traditional healers has contributed to the continuation of cases.

The ongoing presence of Ebola in Guinea poses a threat to its neighbouring Sierra Leone, even as the country celebrated its declaration as Ebola-free on November 7th.

Now in the recovery phase, Trócaire and its partners remain focused on the other challenges facing Sierra Leone. Sierra Leone is ranked as the 183rd country on the Human Development Index, out of 187, and it is one of the six countries in sub-Saharan Africa with the highest hunger levels. ‘Multidimensional’ poverty and inequality remain extremely high, with 72.7% of Sierra Leoneans classified as multidimensional poor, one of the highest rates in the world. Even though the country is now Ebola-free, the population still struggles to cope with the impacts of Ebola on their livelihoods, communities and psychosocial well-being.

While many agencies are unclear of what their role will be in Sierra Leone in the recovery phase, Trócaire is committed to staying to promote the long-term development and dignity in a country full of people who are ready to improve their lives.

You can help support these families by buying the Gift of Seeds and Tools for Sierra Leone this Christmas: www.trocaire.org/gifts/seeds-tools

Mike Denny is a nurse and Infection Prevention & Control specialist from Gallup, New Mexico, U.S. He served as the Infection Prevention & Control Manager for the Ambulance project in Sierra Leone from June to November, 2015. This was his first mission for Handicap International.

What are the services provided by Handicap International’s ambulance project?

It has several aspects. First, we transport patients from their dwellings to Ebola testing centers. Second, we decontaminate their dwellings. At the same time we inform the family and surrounding community about what we are doing and how they can protect themselves. Finally we bring the vehicles, both the ambulances and the decontamination vehicles, back to our base in Hastings for a final decontamination.

What is unique about the services Handicap International provides?

Before this project started an centralized ambulance service for Ebola patients did not exist in Freetown. The local ambulance services do not transport Ebola patients. Transporting Ebola patients requires highly skilled and highly trained professional ambulance drivers and attendants. The dwelling decontaminations must also be done under the strictest of standard operating procedures. The decontamination of the vehicles back at Hastings also requires special skills. We have detailed standard operating procedures for every task and each staff member must master the tasks they are assigned to perform through training and practice.

Because of the staff’s skill level we’ve transported almost 3,800 patients, did nearly 5,000 vehicles decontamination and 1800 dwellings decontamination without a single person being contaminated by the virus.

How are staff members protected from Ebola?

The primary safety factor that we use to ensure that workers remain safe is a team concept. Nobody enters a contaminated area alone and people are always supervised by observers not actively participating in the decontamination operations. By using this team approach we make sure that everybody remains safe and follows the protocols that we established for their safety.

The primary personal protective equipment (PPE) that we use is the coverall. It goes from the ankles to the wrist and then the neck, providing complete coverage of the limbs and torso. We then also use rubber boots, a facemask, goggles, and a hood. We cover it with an apron and three pairs of gloves, two pairs of soft nitrile gloves and a pair of heavy gloves over the top.

What happens on a typical intervention?

People report suspected Ebola cases by dialing 117, which goes to the Command Center in Freetown. The Command Center is where the Ebola response is coordinated. We take calls from the Command Center at our dispatch. When a call comes in, our dispatch manager will get the address and all necessary details to locate referred cases. The dispatch manager then chooses a team to respond, which includes an ambulance to transport the patient, a decontamination vehicle with our equipment, a “dirty car,” which will remove the contaminated belongings of the patient and a “clean car” that will distribute a replacement kit to the family.

Once we arrive on scene our health promoter and team leader will engage with the community, the family, and the patient to inform, explain and determine what type of intervention will be needed. Sometimes people will refuse to let us work, but our health promoter’s job is to convince them to allow us to proceed with the intervention.

In the meantime, the team leader does an assessment of the situation. He will determine if the patient can walk or if he needs to be carried from the site, and where we can set up our operations. This can be a real concern, especially in slum areas, where sometimes our preparation areas can be as far as 200 meters from the dwelling that we’re decontaminating. Once these issues are resolved, the team leader will brief his team and supervise them as they put on their personal protection equipment. Then two hygienists, one carrying a sprayer with a solution of 0.5% chlorine will proceed to the dwelling, followed by the ambulance attendant who will then escort the patient to the ambulance.

If the patient needs to be carried, the ambulance attendant and one of the hygienists will carry the patient on a stretcher. Often dwellings are very small and poorly lit, we have to be very cautious when the staff get inside to pick up the patient. Any rough edges or sharp objects can breach the PPE and expose our workers to the Ebola virus.

Once the patient is safely inside our ambulances and being transported to the Ebola Testing centers, the hygienist with the sprayer will proceed to systematically decontaminate the dwelling with the chlorine spray. The final act is to remove the patient’s mattress and other material, which can be soiled from body fluids. We’ll saturate the mattress with chlorine, and then take it to a dumping site. After the intervention, a “clean car” will bring a new mattress and others replacement items like pillows, mosquito net for when the patient returns to the house.

Tell me about the staff you work with.

I arrived here and they taught me how to fight Ebola. I’ve learned from them every day that I’ve been here. They come from a variety of backgrounds and they’ve all come together to fight Ebola.

I’ve served in the company of heroes. I’m so proud to have fought Ebola with these people. It’s been an honor to lead them. They’ve inspired me to work 10-12 hour days, seven days a week, for five months for this, I do it for them. It’s the best job I ever had. I’m so proud to be part of this effort. I want the world and my fellow Americans to know what these people here in Sierra Leone have done.

Please don’t forget them. They have faced serious consequences as a result of their work due to the stigma of Ebola in Sierra Leone. When they leave our camp after work, some have to hide their IDs, so that people don’t know what their job is. If they didn’t do this, they would not be able to get on a bus, nobody would pick them up. When they get home, they have to hide the fact that they work for Handicap International so their landlords don’t evict them. Many of their families will no longer associate with them. Their wives, parents, and other family members won’t see them anymore since they started working on the Ebola epidemic.

Now that the Ebola outbreak in Sierra Leone seems to be at its end, what is the plan for this project?

Handicap International plans to maintain a staff of Ebola responders. We want to be ready so that if Ebola does come back, we will have trained professionals ready to deal with it.

HIGHLIGHTS

National strategy in Guinea aims at responding to needs of Ebola survivors.

In Guinea, 3,351 cases have tested positive for the Ebola virus, among which 2,083 died, a fatality rate of 62 per cent.

Four Ebola vaccination trials are underway in Sierra Leone.

Ebola survivors share their stories from Guinea, Liberia and Sierra Leone.

KEY FIGURES

Population in Guinea, Liberia, Sierra Leone 20.8 million

Total cases 28,635

Deaths 11,314

FUNDING

US$6.6 billion Pledged (Sep 2014 – May 2015)

$ 4.6 billion received (Sep 2014 – May 2015)

CAMEROON
CHOLERA OUTBREAK IN NORTH REGION
A cholera outbreak has erupted in North region. Over the past month, 36 cases have been reported, 30 of them treated. No fatalities have been recorded so far. Preventive medical measures, treatment as well as population sensitization are ongoing.

CENTRAL AFRICAN REPUBLIC (CAR)
SEVEN KILLED IN CLASHES
At least seven people were killed and hundreds of shelters for internally displaced persons (IDPs) torched following intercommunal fighting that erupted on 10 November in the western Batangafo locality. Armed men also looted the premises of a humanitarian organization. Around 30,000 IDPs have now sought safety at various military and NGO compounds in the area. Water and emergency latrines are the most critical needs.

CHAD
STATE OF EMERGENCY DECLARED IN LAC REGION
The Chadian Government on 9 November declared a state of emergency in Lac region owing to increasing attacks by suspected Boko Haram members. Under the state of emergency, the Governor of the region can restrict movement of people and vehicles and search homes among other measures. The Government also announced the release of US $4.8 million to boost agriculture, pastoralism, education and health among others in the region.

NIGER
GUNMEN RAID VILLAGE IN BOSSO
Suspected Boko Haram gunmen raided a village in the south-eastern Bosso area on 11 November, killing five civilians. The Nigeria-based armed group has been blamed for a series of attacks on Bosso and neighbouring Diffa region since early this year.

NIGERIA
ARMY FREES 61 IN BORNO
The Nigerian army said on 12 November it had rescued 61 people, mainly women and children, during an operation against Boko Haram in Borno State.
Last month, the army had announced rescuing more than 330 people, also mostly women and children, held by the armed group in their Sambisa forest hideout.

EVD REGIONAL
LAST PATIENT IN GUINEA DISCHARGED
Guinea’s last confirmed Ebola case, an 18-day-old baby, has been discharged from an Ebola treatment centre in Conakry. If no new cases emerge in the next 42 days, WHO can declare Guinea free of Ebola transmission. Over the weekend, the last 68 Ebola contacts under surveillance had already been released from quarantine. In Liberia, which was declared Ebola-free on 3 September, Ebola Treatment Units (ETUs) are being closed down across the country except those in Lofa county near the border with Guinea. Meanwhile,
ETUs are being set up in permanent health facilit

CAMEROUN

ÉPIDÉMIE DE CHOLÉRA DANS LE NORD

Une épidémie de choléra a débuté dans la région du nord du Cameroun. Au cours du dernier mois, 36 cas ont été signalés, 30 d'entre eux traités. Aucun décès n'a été noté jusqu'ici. Des mesures médicales préventives, le traitement ainsi que la sensibilisation de la population sont en cours.

RÉPUBLIQUE CENTRAFRICAINE (RCA)

SEPT TUÉS DANS DES AFFRONTEMENTS

Au moins sept personnes ont été tuées et des centaines d'abris pour les personnes déplacées internes (PDI) incendiés suite aux combats intercommunautaires qui ont éclaté le 10 novembre dans la localité de Batangafo, à l’ouest du pays. Des hommes armés ont également pillé les locaux d'une organisation humanitaire. Environ 30 000 PDI ont cherché refuge dans des camps militaires et d’ONG dans la région. De l’eau et des latrines d'urgence sont les besoins les plus critiques.

TCHAD

ETAT D’URGENCE DÉCRÉTÉ DANS LA RÉGION DU LAC

Le 9 novembre, le gouvernement tchadien a déclaré l'état d'urgence dans la région du Lac en raison de l'augmentation des attaques par des membres présumés de Boko Haram. Sous l'état d'urgence, le Gouverneur de la région peut restreindre le mouvement des personnes et des véhicules et mener des perquisitions de domicile, entre autres mesures. Le gouvernement a également annoncé le déblocage de 4,8 millions dollars US pour relancer l'agriculture, le pastoralisme, l'éducation et la santé, entre autres, dans la région.

NIGER

RAID D’HOMMES ARMÉS DANS UN VILLAGE À BOSSO

Le 11 novembre, des hommes armés présumés appartenir à Boko Haram ont attaqué un village dans la région de Bosso, au sud-est, tuant cinq civils. Le groupe armé basé au Nigeria a été accusé d’avoir mené une série d'attaques à Bosso et dans la région voisine de Diffa depuis le début de cette année.

NIGERIA

L’ARMÉE LIBÈRE 61 PERSONNES A BORNO

Le 12 novembre, l'armée nigériane a déclaré avoir libéré 61 personnes, principalement des femmes et des enfants, au cours d'une opération contre Boko Haram dans l‘état de Borno. Le mois dernier, l'armée avait annoncé le sauvetage de plus de 330 personnes, également des femmes et des enfants pour la plupart, détenus par le groupe armé dans leur repaire de la forêt de Sambisa.

MALADIE A VIRUS EBOLA (MVE) / RÉGIONAL SORTIE DU DERNIER PATIENT EBOLA EN GUINÉE

Le dernier cas Ebola MVE confirmé en Guinée, un bébé de 18 jours, est sorti d'un centre de traitement Ebola à Conakry. Si aucun nouveau cas n’apparaît dans les 42 prochains jours, l'OMS peut déclarer la Guinée exempte de transmission du virus Ebola. Au cours du week-end, les 68 derniers contacts Ebola sous surveillance avaient déjà été libérés de quarantaine. Au Libéria, déclaré exempt le 3 Septembre, les Unités de Traitement Ebola (UTE) sont en train de fermer dans l'ensemble du pays, excepté celles du comté de Lofa, près de la frontière avec la Guinée. Pendant ce temps, des UTE sont en train d’être mises en place dans les établissements de santé permanents.

Highlights:

• On 7 November 2015, the World Health Organization declared the end of the Ebola outbreak in Sierra Leone. The end of the outbreak was marked by a ceremony hosted by His Excellency, Dr. Ernest Bai Koroma, President of the Republic of Sierra Leone, and attended by UNICEF, international organizations, NGOs and the donor community. Although an important milestone, it was reiterated that enhanced surveillance must continue so that the country is ready for any possible future outbreaks, and work must also intensify to support those affected by the outbreak and to build a resilient recovery.

• UNICEF is supporting the Government of Sierra Leone in the transition and post-Ebola recovery phases in several areas such as strengthening health system resilience and the access to quality learning for all children, reinforcing community engagement and improving survivor engagement.

• UNICEF continued to support the implementation of Project Shield. The mapping of survivors in Bombali district was completed during the reporting period. To date, 1,938 survivors have been registered and verified (900 in Western Area, 418 in Bombali, and 620 in Port Loko). In Port Loko, UNICEF provided technical support to the Ministry of Social Welfare, Gender and Children’s Affairs (MSWGCA) to map existing services for survivors across the 11 chiefdoms in the district.

SECTOR OVERVIEW

Water, sanitation, and hygiene (WASH) programs represent vital components of USAID Office of U.S. Foreign Disaster Assistance (USAID/OFDA) responses to rapid-onset disasters and complex emergencies, as disaster-affected populations are more susceptible to illness and death from waterborne and communicable diseases. WASH interventions in emergencies often include promotion of good hygienic practices, construction or repair of latrines, removal of solid waste, and provision of safe, treated water. Activities such as building latrines and establishing waste removal systems can prove even more challenging in areas with high water tables, hard rock sites, and dense populations.
USAID/OFDA also links emergency WASH activities with transition and development programs funded by other USAID offices and incorporates institutional partners—such as local governments—in program planning and implementation to promote the sustainability of water- and hygiene-focused projects. In Fiscal Year (FY) 2015, USAID/OFDA provided $213.4 million to support WASH programs in more than 35 countries.

WEST AFRICA EBOLA OUTBREAK RESPONSE

During FY 2015, USAID/OFDA continued its response to the largest Ebola Virus Disease (EVD) outbreak in history that has primarily affected Guinea, Liberia, and Sierra Leone and resulted in nearly 11,300 deaths, according to the UN World Health Organization (WHO). Addressing the outbreak has required close coordination among international organizations and national governments, with USAID/OFDA leading U.S. Government (USG) EVD response activities in West Africa.

The USAID/OFDA WASH team collaborated with the U.S. Centers for Disease Control and Prevention (CDC), the UN Children’s Fund (UNICEF), West African ministries of health and public works, and many other national and international organizations to address critical WASH needs and break the chain of EVD transmission. At EVD treatment facilities, USAID/OFDA supported multiple systems for water supply treatment, sanitation, and solid waste disposal to ensure patient care and essential infection prevention and control practices. In communities across affected countries, USAID/OFDA funded social mobilization teams to promote hand washing and other hygiene practices, while also supporting environmental health technicians to conduct safe and dignified burials to reduce the risk of EVD infections. With the number of EVD cases declining at the end of FY 2015, USAID/OFDA also evaluated how to better contain potential future outbreaks, including through support to research that improves disinfection procedures and increases understanding of the virus’ survival in the environment.

PROVIDING EMERGENCY WASH SUPPORT FOLLOWING THE NEPAL EARTHQUAKE

On April 25, 2015, a magnitude 7.8 earthquake struck Nepal, resulting in nearly 9,000 deaths, damaging or destroying more than 885,000 houses, and affecting approximately 8 million people. The earthquake damaged rural water systems throughout the country, limiting the availability of safe drinking water. Residents of damaged and destroyed homes were left without access to basic sanitation facilities, putting them at heightened risk of disease outbreaks during the coming monsoon season.

Immediately following the earthquake, USAID/OFDA partnered with multiple organizations to repair and rehabilitate damaged water systems in rural areas. USAID/OFDA also provided funding for non-governmental organization (NGO) partners, including ACTED, Mercy Corps, and Save the Children, to support affected households through integrated shelter and WASH interventions, providing temporary sanitation facilities and essential hygiene items that residents lost during the earthquake. In addition, USAID/OFDA supported the strategic stockpiling of point-ofuse water treatment solutions, such as chlorine and hand-washing stations, in areas at increased risk of disease outbreak during the June-to-September and October-to-December monsoon seasons.

SUPPORTING WASH ASSISTANCE FOR CONFLICT-AFFECTED SYRIANS

Prior to the onset of the civil war in Syria in March 2011, Syrians were accustomed to robust water and sanitation services across much of the country. As the conflict enters its fifth year, these systems have repeatedly sustained damage, and Syrians have had to adapt to increasingly limited access to basic services. With at least 7.6 million Syrians internally displaced, people are frequently forced to seek shelter in structures and areas that offer limited or no access to safe drinking water and sanitation facilities.

In response, USAID/OFDA provided more than $53 million to support essential WASH services for Syrians during FY 2015. In particular, USAID/OFDA supported life-saving interventions through rehabilitating damaged water supply systems, establishing new water access points, monitoring water quality, and supporting water-trucking activities. With USAID/OFDA support, NGO partners also conducted hygiene promotion activities and upgraded waste water systems in collective shelters, health facilities, and communities to assist Syrians in meeting basic hygiene and sanitation needs.

In the past decade, chronic food insecurity and malnutrition, cyclical drought, locust infestations, seasonal floods, disease outbreaks, and recurrent complex emergencies have presented major challenges to vulnerable populations in the West Africa region. Between FY 2006 and FY 2015, USAID’s Office of U.S. Foreign Disaster Assistance (USAID/OFDA) and USAID’s Office of Food for Peace (USAID/FFP) have provided humanitarian assistance to address the impacts of a diverse range of crises, including food insecurity and malnutrition in the Sahel; complex emergencies in multiple countries; disease outbreaks, including cholera, meningitis, measles, and Ebola Virus Disease (EVD); a volcano in Cabo Verde; and flooding throughout the region.

Between FY 2006 and FY 2015, USAID provided more than $2.8 billion in humanitarian assistance to West Africa, including more than $1.7 billion from USAID/FFP for food assistance in the form of U.S.-purchased food, locally and/or regionally procured food, cash transfers for food, food vouchers, and related activities. USAID/OFDA provided more than $1.1 billion for agriculture and food security, economic recovery and market systems (ERMS), health, nutrition, protection, shelter, and water, sanitation, and hygiene (WASH) interventions, as well as support for humanitarian coordination, logistics, and the provision of relief commodities.

Over the last decade, USAID has sent Disaster Assistance Response Teams (DARTs) to the region—including to Guinea, Liberia, and Sierra Leone during FY 2014 and FY 2015, as well as Mali in FY 2015, for the EVD outbreak.

USAID also sent multiple humanitarian assessment teams to Côte d’Ivoire in FY 2011 following large-scale insecurity and displacement and to the Sahelian countries in FY 2012 in response to food insecurity.

USAID response activities in West Africa focus on meeting immediate needs while supporting recovery activities to build resilience against future crises. To assist conflict-affected populations, USAID supports the provision of food assistance, emergency relief supplies, basic services, and protection activities. Following periods of below-average agricultural yields, droughts, and floods, USAID programs aim to improve livestock health and crop production, strengthen management of acute malnutrition, support livelihoods activities, and improve water and sanitation conditions. In addition to short-term urgent assistance for vulnerable populations, USAID/OFDA supports national and regional structures to strengthen early warning and response systems. To complement emergency assistance interventions, USAID/OFDA’s West Africa disaster risk reduction strategy seeks to reduce the risks and effects of acute malnutrition, displacement, and epidemics through programs that decrease community and household fragility and increase resilience to future shocks.

Likewise, USAID/FFP supplements its emergency food assistance with development programs that aim to address the underlying causes of food insecurity and increase the resilience of vulnerable populations to cope with future shocks while continuing to meet the immediate needs of affected populations. In West Africa, USAID/FFP development food assistance programs work with communities to improve agricultural productivity, health, and natural resource management; reduce chronic malnutrition; and strengthen local capacity among civil society groups.

SUMMARY

• Guinea reported no confirmed cases of Ebola virus disease (EVD) in the week to 15 November. The most recent case from Guinea was reported on 29 October. That case is a child who was born in an Ebola treatment centre, and who was delivered by medical staff wearing full personal protective equipment (PPE). As such, no contacts are associated with this case, and all contacts associated with previous cases have completed their 21-day follow-up period. A second consecutive blood sample from the child tested negative for Ebola virus on 16 November.

• On 7 November WHO declared that Ebola virus transmission had been stopped in Sierra Leone. The country has now entered a 90-day period of enhanced surveillance, which is scheduled to conclude on 5 February 2016. Both Liberia and Sierra Leone have now achieved objective 1 of the phase 3 response framework: to interrupt all remaining chains of Ebola virus transmission.

• Robust surveillance measures are essential to ensure the rapid detection of any reintroduction or reemergence of EVD in currently unaffected areas, and are central to the attainment of objective 2 of the phase 3 response framework: to manage and respond to the consequences of residual Ebola risks. To that end, Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD. In the week to 15 November, 26 493 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1496 alerts were reported from 14 of 14 districts in the week ending 8 November (the most recent week for which data are available).

• As part of each country’s EVD surveillance strategy, blood samples or oral swabs should be collected from any live or deceased individuals who have or had clinical symptoms compatible with EVD. In the week to 15 November, 9 operational laboratories in Guinea tested a total of 587 new and repeat samples from 14 of the country’s 34 prefectures. 91% of all samples tested in Guinea were swabs collected from dead bodies. By contrast, 85% of the 757 new and repeat samples tested in Liberia over the same period were blood samples collected from live patients. In addition, all 15 counties in Liberia submitted samples for testing by the country’s 4 operational laboratories. 1164 new samples (the lowest total reported in 2015) were collected from all 14 districts in Sierra Leone and tested by 9 operational laboratories. 93% of samples in Sierra Leone were swabs collected from dead bodies.

• 463 deaths in the community were reported from Guinea in the week to 15 November. This represents approximately 21% of the 2248 deaths expected based on estimates of the population and a crude mortality rate of 11 deaths per 1000 people per year. All but 1 of the 463 reported deaths were buried safely. Equivalent data are not yet available for Liberia. In Sierra Leone, 1332 reports of community deaths were received through the alert system during the week ending 8 November (the most recent week for which data are available), representing approximately 64% of the 2075 deaths expected each week based on estimates of the population and a crude mortality rate of 17 deaths per 1000 people per year.

Introduction

1. Thanks to the considerable efforts of the many national and international actors working on the response to the Ebola outbreak in West Africa, and the strong partnerships between them, the incidence of the disease has decreased markedly since the height of the outbreak. The contribution of resources thus far by governments, other contributing partners and the Ebola-affected countries themselves has been significant in this regard. Sustainment of these partnerships remains much needed to end the outbreak and prevent re-emergence of the disease.

2. Today, transmission is ongoing and the risk of reintroduction due to virus persistence has led to a shift in the strategy for achieving and maintaining zero cases. Members of the Interagency Collaboration on Ebola1 , a coordination body convened by the World Health Organization, have developed a Strategic Framework for Phase 3 of the Ebola Outbreak Response. That document offers a plan for achieving and sustaining ‘resilient zero’ in Guinea, Liberia and Sierra Leone through actions to be undertaken by Ebola-affected communities and national authorities, with support from the international community. The Strategic Framework was developed, in September 2015, through consultations that build on the national strategies discussed and agreed to with national governments and national and international stakeholders. Barring unforeseen developments, the funding needs of organisations implementing the Phase 3 Framework Strategy, as set out in this document, are valid until 31 March 2016.

3. The purpose of the Phase 3 Strategic Framework is to incorporate new knowledge and tools into the ongoing Ebola response and recovery work. It includes a surveillance strategy designed to promptly detect new, suspected cases of Ebola and deaths so as to trigger an appropriate response, including rapid diagnosis, case isolation and management, contact tracing and safe burial, along with the identification of transmission chains. This third phase in the response effort builds upon Phase 1 (the rapid scale-up of treatment beds, safe and dignified burial teams and behaviour change capacities), which was active from August to December 2014. In addition, it builds on phase 2 (enhanced capacities for case finding, contract tracing and community engagement), established from January to August 2015.

4. This accompanying document offers an overview of the funding needs and requirements, for the period 1 November 2015 to 31 March 2016, of UN agencies, their implementing partners and other organisations for whom information about bi-lateral support was provided that are working in support of the Phase 3 Strategic Framework. The organisations’ needs are based on the assumption of continued in-kind support in critical areas such as, inter alia, laboratory and diagnostics capacity. Although the resource needs presented are valid until the end of March 2016, national governments and participating organisations intend, as part of ongoing prevention and recovery efforts, to continue implementing many of the activities beyond that date.

5. Figure B5 in this document provides a list of the UN agencies and other organisations implementing the Phase 3 Strategic Framework who participated in the implementation planning process and provided information about their funding shortfalls through to 31 March 2016. Figure A2 lists, in addition to those actors, UN agency implementing partners and other organisations operating with bi-lateral support about which programmatic information was provided.
   There are in all likelihood some organisations supporting the Phase 3 Strategic Framework that are not reflected in this report, in particular those receiving bi-lateral support and/or not participating in UN coordination mechanisms.
   In that connection, this document does not provide an exhaustive list of all organisations supporting the Framework and their funding needs. For a comprehensive understanding of the objectives, activities, timeline and funding requirements of the Framework Strategy, reference should be made to the Phase 3 Strategy paper (see http://apps.who.int/iris/bitstream/10665/184693/1/ ebola_resilientzero_eng.pdf?ua=1).

SECTOR OVERVIEW

As part of its efforts to ensure a rapid response to humanitarian emergencies around the world, USAID’s Office of U.S. Foreign Disaster Assistance (USAID/OFDA)—the lead U.S. Government (USG) office for international disaster response—stores emergency relief supplies at strategically located warehouses in Miami, Florida; Pisa, Italy; Dubai, United Arab Emirates; and Subang, Malaysia. Stockpiled humanitarian relief commodities include blankets, hygiene kits, kitchen sets, water containers, and plastic sheeting for emergency shelter.

In addition to facilitating the storage of emergency relief commodities, USAID/OFDA deploys logistics personnel when a disaster strikes to assist directly with USG response efforts. With the support of Washington,D.C.-based specialists, logistics personnel manage the transport and consignment of relief commodities to USAID/OFDA partners operating in disaster-affected areas. USAID/OFDA’s Logistics Unit provides technical assistance to non-governmental organizations (NGOs), UN agencies, and host government counterparts in the immediate aftermath of a disaster. The unit also supports disaster risk reduction efforts to mitigate the impact of future disasters.

In Fiscal Year (FY) 2015, through grants and in-kind contributions to humanitarian partners, USAID/OFDA provided more than $340 million for emergency relief commodities and associated transport, as well as for other logistical support.

UNDP Digitization Initiative Takes Steps To Preserve Historic Climate Data in Sub-Saharan Africa

By Excellent Hachileka

Climate data is the lifeblood of early warning systems and the cornerstone for resilience building efforts. It not only allows us to monitor adverse impacts across development sectors, populations and ecosystems, but it also helps countries to prepare for and adapt to the realities of climate change. This priceless information can be analyzed and applied to protect development gains and aid in the achievement of National Adaptation Plan goals.

Unfortunately in many parts of sub-Saharan Africa, this important data – often recorded with pen and paper – is being lost at a remarkable rate. Civil War, decay and the sands of time are literally erasing our historical record of climate in the region. In order to preserve this essential data, it is critical that Africa take steps to digitize this information.

At the request of the governments of the Gambia, Malawi, Sierra Leone, Tanzania, Uganda and Zambia, the UNDP Programme on Climate Information for Resilient Development in Africa (CIRDA) is taking steps to preserve this data. Two experts – including myself – where commissioned by CIRDA to meet with National Hydrological and Meteorological Services to provide guidance on digitization efforts and create a plan to capture digital records, especially information relevant to agriculture, fishing and flood management.

The lessons learned from our initial efforts to provide guidance on digitization can be applied to other countries, and is an important first step in securing the historic record of Africa’s climatic past.

Climate data generally falls into two categories: historical data and data from recent and current observations.

While most people understand the importance of current and recent climate data, fewer appreciate the equal importance of historical climate data. Historical data allow us to establish long-term trends, which in turn helps us understand and better plan for future changes in climate. They also help us develop climate models and seasonal forecasts, and provide the foundational datasets used for adaptation studies at local, national and regional scales.

For example, climate models are mathematical representations of the interactions between the atmosphere, oceans, land surface, ice and the sun. Once a climate model is developed, it has to be tested to find out if it works. And since we can’t wait for 30 years to see if a model is any good or not, the models have to be tested against the past in a process that is called “hindcasting.” These models rely on historical observations. The simple assumption of hindcasting is that if a model can correctly predict current trends from a starting point somewhere in the past, one can expect it to predict with reasonable certainty what might happen in the future.

Meteorological data observations in most African countries date back to the early 19th Century (for example, in Tanzania the first meteorological observation was made along the coast in 1850). Once recorded on paper, the observations are kept in various formats in data archives located in meteorological agencies. But this historical data is recorded largely on paper and, depending on the age of the paper and the condition of the archives, some of the data is unreadable or is wearing out at dramatic rates, while other data is recorded with handwritten ink that fades over time. This is a slow-motion tragedy. Historical information is an invaluable resource for a continent that is already being hit hard by climate change.

Some of these countries have almost one billion pages of historical data that is not digitized. That’s a lot of paper and a lot of work, but it also represents decades of historical information that can prove critical in long-term forecasts. These billion pages represent the records from just the six countries we visited, and the situation is similar throughout much of Africa.

Many of the National Hydrological and Meteorological Services we visited expressed a great deal of concern in the ongoing loss of this information. For instance, a chief meteorologist at the Zambia Meteorological Department told me that one day he woke up to learn that a colleague in his office had set a large portion of climate data on fire in a bid to create more office space – literally, several years of irreplaceable data had just vanished into smoke. In other places, the poor conditions of archives have led to climate data being eaten up by termites or destroyed when offices are flooded. In Sierra Leone, the Meteorology Department points to thousands of historical climate datasets that were lost during the civil war.

As should be clear, preserving historical data isn’t just an exercise in saving bits of old paper – it is an investment that can truly save lives and enhance climate risk preparedness by helping to create better forecasting, better projections and better early warning systems. Indeed, ensuring that all historical climate data is rescued and digitized can contribute to improving efficiency and effectiveness in the provision of climate services. Perhaps more importantly, it is an essential building block to fortify our societies’ resilience against the effects of climate change.

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Digging For Data

Excellent Hachileka is an Environmentalist and Development Expert with over 20 years of environmental management and development work in sub-Sahara Africa. He is currently serving as a Programme Specialist in the Disaster Risk Reduction and Climate Change Cluster at the UNDP Regional Service Centre for Africa (RSCA) where he provides technical support to UNDP Country Offices and the Regional Economic Communities in Africa. His work focuses on the development of integrated disaster risk reduction and climate change policies, legislation, regulatory frameworks and strategies. Before joining the RSCA, he worked as a Climate Change Policy Specialist at UNDP Zambia. He has also worked for 12 years with the International Union for Conservation of Nature (IUCN) as Country Director for Zambia and Zimbabwe, and as IUCN’s Regional Climate Change Programme Coordinator for Eastern and Southern Africa. Excellent was also a Lecturer and Researcher in Environmental Management and Natural Resource Economics at the University of Zambia. He holds a BSc in Physical Geography (University of Zambia) and a Master’s Degree in Environmental Management (University of Stirling, Scotland).

18 November 2015 – Transmission of Ebola has been stopped in Liberia and Sierra Leone, while Guinea is now treating a baby believed to be its last case, the United Nations Special Envoy on Ebola, Dr. David Nabarro, reported today, underscoring that his top priority is to make sure the thousands of survivors and their families across West Africa have access to the support they need.

“More than 15,000 people who had Ebola that survived still face a lot of challenges,” Dr. Nabarro told a press conference at UN Headquarters. “There are risks that they face; there are risks that their families face. And there are risks that they might unwittingly pose to other people.”

Saying “they have a tough time” because “they’re distressed” and “not trusted,” as well as being “a subject of a lot of stigma, Dr. Nabarro said he wants to be sure that every person who survived Ebola can access a comprehensive package of care that helps them, and that help their communities.

“That means that all those who survived, need to be helped to maintain hygiene, and also if they are meant to practice safe sex, they need proper counselling and follow-up testing,” he said. “They need eye care because we know that vision can suffer after Ebola. They need medical support. Often they have terrible joint pains. They need sexual health systems. They need psychosocial support. Sometimes they need economic support.”

“And, they really need to be treated as the heroes of the outbreak,” which killed more than 11,300 people, he said. “So, trying to make sure that survivors and their families can access the support they need is my priority number one.”

“My priority number two is that I want to be sure, that in all the affected countries there is capacity to protect, to detect and to respond in place, so that if there is any resurgence, and any report of suspected new cases, the response is there and that we don’t get caught unaware,” the envoy said. “So, together with my colleagues I’ll be checking up to see and to ensure that rapid response capacity is in place.”

Continuing, Dr. Nabarro explained that his third priority is to honour those who have been affected by this outbreak and to make sure that the world can deal with this kind of problem better in the future.

And as part of the last priority, the envoy said the Advisory Group on the Reform of the agency’s work presented its first report to the UN World Health Organization (WHO) Monday, with three key recommendations, which he highlighted:

• The first is that WHO must ensure that it’s always neutral, independent, [and] free of any kind of political control when it is making judgements about health risks and sharing those with the rest of the world;

• Secondly, WHO needs a powerful programme of outbreaks and emergencies that is integrated across the whole organization with the staff and finance that it needs to respond to threats the kind we have seen with Ebola;

  • that it has standby partnerships agreements with organizations involved in humanitarian and infectious disease work throughout the world that can be activated when needed;
    
  • that it has funds that it requires that can be promptly disbursed and accessed as soon as there is an alert;
    
  • and that it participates as leader of the humanitarian community in case of health threats;

• And third is that we are calling for an independent oversight group to be set-up to help the Director-General of WHO and its members to be sure that it is performing in a way that the world needs.

Meanwhile, Dr. Nabarro said while the Ebola outbreak in the worst affected countries in West Africa is “not completely over,” he said the transmission of the virus has stopped in Liberia and in Sierra Leone” and in Guinea, “the last confirmed infected person in Guinea – is a three week old girl called Nubia.”

“Unfortunately, her mother died but she is in a treatment unit in Conakry and she tested negative for the second time on Monday,” he said. “We are hopeful that she will be the last case in Guinea.”

18 novembre 2015 – L'Envoyé spécial du Secrétaire général pour Ebola, le Dr. David Nabarro, s'est félicité mercredi des progrès réalisés dans la lutte contre cette maladie dans les trois pays les plus touchés, le Liberia, la Sierra Leone et la Guinée, mais a rappelé que l'épidémie n'était pas terminée.

« Le nombre de personnes avec Ebola en Afrique de l'Ouest a vraiment baissé ces derniers mois. Mais l'épidémie n'est pas complètement finie », a dit le Dr. Nabarro lors d'une conférence de presse au siège de l'ONU à New York.

Il a rappelé que la transmission du virus avait été stoppée au Liberia et en Sierra Leone. « Ces deux pays sont dans une période de surveillance renforcée de 90 jours, ce qui veut dire une vigilance élevée », a-t-il précisé.

Concernant la Guinée, la tendance est aussi positive mais il y a encore des risques de transmission. « Les efforts se concentrent sur l'objectif zéro. Nous avons eu des nouvelles positives. Hier, le pays a commencé le compte-à-rebours de 42 jours après le dernier cas », a expliqué l'Envoyé spécial.

La dernière personne infectée dans ce pays est une petite fille âgée de trois semaines appelée Nubia. Sa mère est décédée et le bébé se trouve dans une unité de traitement dans la capitale, Conakry, où elle a été testée négative pour la deuxième fois lundi. « Nous espérons qu'elle soit le dernier cas en Guinée », a dit le Dr Nabarro, qui a précisé que Nubia recevait des traitements expérimentaux mais que l'interprétation des résultats n'était pas facile concernant les très jeunes enfants qui ont un système immunitaire pas complètement développé.

S'agissant des quelque 15.000 personnes qui ont été infectées par Ebola et ont survécu, l'Envoyé spécial a souligné qu'elles étaient confrontées à l'angoisse, à la méfiance et à la stigmatisation.

Selon lui, il faut s'assurer que ces survivants et leurs familles puissent avoir accès au soutien dont ils ont besoin pour gagner leur vie et recevoir les soins médicaux nécessaires concernant notamment des douleurs récurrentes au niveau des yeux et des articulations.

Quant au redressement des trois pays les plus affectés, il a souligné que cela prendrait du temps et que l'impact socio-économique d'Ebola allait continuer à se faire sentir longtemps après la fin de l'épidémie. Le Dr. Nabarro a encouragé la communauté internationale à poursuivre son soutien au Liberia, à la Sierra Leone et à la Guinée pour les aider à renforcer leur résilience.

Getting to zero cases

From a peak of over 950 confirmed cases per week at the height of the Ebola outbreak, current case counts in West Africa are the lowest in over 12 months. In week 46, ending on 15 November, a total of 28 664 EVD cases including 11 313 deaths have been reported in three countries with widespread and intense transmission (Guinea, Liberia, and Sierra Leone).

Seven countries (Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom, and the United States of America) have previously reported a case or cases imported from a country with widespread and intense transmission.

Some features inside this issue

Epidemiological situation overview

As of week 45, edning 8 November, a total of 28 599 cases including 11 299 deaths have been reported in three countries with widespread and intense transmission namely Guinea, Liberia and Sierra Leone

Focus on Guinea: Door-to-door case-finding operations

Since 28 September a WHO-funded active casefinding operation is ongoing in the Conakry districts of Dixinn and Ratoma and in Forecariah district.

Phase 3 Ebola response: Early recovery

Investment in Phase 3 Ebola response activities will need to continue alongside, and complement, early recovery efforts for the health sector

Goal:

Enhance food security, economic growth, resilience, and poverty reduction in West Africa through an integrated common market

Life of Program:

5/2015 – 5/2020

Total USAID Funding:

$5,600,000

Geographic Focus:

Benin, Burkina Faso, Cape Verde, Côte d’Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo.

The Food Across Borders Program (ProFAB) grew out of the USAID-sponsored Food Across Borders Conference in January 2013. Participants agreed on a region-wide technical agenda, referred to as the Accra Agenda, which identified primary barriers to trade in staple agricultural commodities. Public and private sector representatives highlighted five central barriers: road harassment, export restrictions, rules of origin, clarity of sanitary/phyto-sanitary veterinary regulations, and taxation. Hub Rural and CILSS have played an important role in building the foundation for launching ProFAB as part of the Accra Agenda.

Program Description

ProFAB increases food security and economic growth by expanding the volume and value of intra-regional agricultural trade. The program supports a variety of activities contributing to a more integrated common market in West Africa. The Economic Community of West African States (ECOWAS) and the West African Economic and Monetary Union (WAEMU) house the ProFAB observatory and incorporate ProFAB results and outcomes into their regional policy efforts. ECOWAS, WAEMU, and USAID led the ProFAB steering committee. Hub Rural contains a coordination unit among the partners, including civil society, research, private sector and producer organizations.

Program Objectives

• Formulate and implement effective regional policies and strategies to address primary barriers to regional agricultural trade
• Expand access to reliable information on cross-border trade data and regulatory requirements
• Strengthen results-oriented trade advocacy platforms

Key African Partners:

ECOWAS, WAEMU, Permanent Intergovernmental Committee for Drought Control in the Sahel (CILSS)

Key Implementing Partners:

CILSS, Lead Implementing Partner, with: Hub Rural, Borderless Alliance, Environmental Development Action in the Third World - African Center for Trade, Integration and Development (ENDA-CACID)

HIGHLIGHTS

• WHO declares the end of the EVD outbreak in Sierra Leone

• GoL reports new confirmed cases of EVD

• Guinea completes two consecutive weeks without a new case

• Survivor support high priority for UN Special Envoy for Ebola

West Africa - Ebola Outbreak, Fact Sheet #4, Fiscal Year (FY) 2015 (as of November 20, 2015)

INTRODUCTION

The current Ebola crisis has killed or infected thousands of people and caused massive disruptions to peoples’ lives and Sierra Leone’s economy. This briefing argues that the crisis offers three main lessons to the government and companies working in Sierra Leone.

• The first is that insufficient spending on health has left the country vulnerable to the spread of Ebola.

• The second is that the government is giving away too much revenue in tax incentives to foreign investors that should be spent on promoting the health of the country’s people.

• The third is that companies in Sierra Leone receiving those generous tax incentives should now recognise that these are short-sighted and that their own self-interest lies in contributing greater tax revenues and championing better public services.

Freetown, Nov. 18, 2015 (MOHS) – The Chief Medical Officer Ministry of Health and Sanitation, Dr. Brima Kargbo has reiterated his ministry’s readiness to effectively implement key interventions within the Recovery Phase of the Post Ebola period.

The Chief Medical Officer was addressing a one day Consultative conference on the status of Emergency obstetric and newborn care facilities in Sierra Leone held at the National Stadium Atlantic hall in Freetown.

Dr. Brima Kargbo reiterated the need to revisit the structure for the survival of the vulnerable children of Sierra Leone with a view to providing quality maternal and newborn care in all health facilities in the country.

The Ministry of Health in its efforts to reducing maternal and newborn deaths, Dr. Kargbo said is poised to ensuring that the key enablers for the compliance of all health facilities is accomplished with the provision of the basic service during the Ministry’s Post Ebola Recovery Plan to reduce the high incidence of infant and maternal deaths. “Before the launch of the Free Health Care there was high incidence of maternal and child deaths but the launching by President Koroma in 2010 made a significant dramatic turn when pregnant women, lactating mothers and children under five years in their high numbers accessing the facilities. The gains made by the Ministry with the Free Health Care Initiative, Dr. Kargbo told his audience then became a shattered hope for the future with the Ebola outbreak. This shattered hope for the future the Chief Medical Officer said now poses a challenge for the Ministry and its partners in the six to nine months Recovery Plan.

The lessons learnt from the Ebola outbreak Dr. Kargbo assured his audience would be used to ensure health workers and patients’ safety in all health facilities are executed towards building a resilient health system across the country.

he Director of Reproductive and Child Health, Ministry of Health and Sanitation, Dr. Santigie Sesay in his presentation dilated on issues relating to maternal, newborn and child health outcomes, How Emergency Obstetric and Newborn Care can support broader aims of Maternal, Newborn and Child health, and key challenges.

JAK/KK/MOHS/SLENA