West Africa - Ebola Outbreak, Fact Sheet #7, Fiscal Year (FY) 2016 (as of January 21, 2016)

A second case of Ebola was confirmed late Wednesday, 20 January after the blood sample of a high risk contact linked to the index case, tested positive for Ebola Virus Disease.

The 38 year old aunt to the index case, was an active caregiver to the index case during her illness and also helped prepare the body for burial upon death on 12 January 2016. The swab tests of the index case tested EVD positive on 14 January 2016.

'Aunt M' moved to a Voluntary Quarantine Facility on Monday, 17 January 2016 with four other high risk contacts, after initial monitoring at a quarantined home.

She developed a fever with diarrhea early 20 January at the VQF, was transferred from the VQF to the isolation facility, where an initial blood specimen was taken; the specimen tested positive for EVD twice. Subsequent testing took place at another independent laboratory that doubly confirmed the results late on the same day.

'Aunt M' has been transferred to the Ebola Treatment Unit at Military 34 hospital in Freetown where she is receiving treatment.

While this new case causes understandable anxiety after all known transmission chains were formally halted on 7 November 2015, the government's rapid response to find, identify this high risk contact early, move her to a VQF, monitor her closely for symptoms and rapidly isolate and provide treatment when she showed symptoms and tested positive, proves that our response systems remain robust. But the risk of further infection remains high for as long as monitoring of located high risk contacts continue and while missing contacts remain unlocated.

The general public is urged to continue to think Ebola, to call 117 to report suspicious illnesses and all deaths, not to wash dead bodies and adhere to safe hand hygiene practices and to seek early treatment if you suspect that you may have been in contact with the index case. We have fought Ebola once and won. Together we can do it again.

Guinea - Following the confirmation of a new Ebola case in Sierra Leone on January 12 – and confirmation of another case on January 20th – IOM and its partners are reactivating cross-border health screening at Guinea’s borders with Sierra Leone and reinforcing their surveillance capacity in Forecariah Prefecture, the border area closest to the outbreak.

At the request of Guinea’s National Emergency Operations Center and the Ministry of Health, IOM immediately reinforced the health screening checkpoint at the Pamelap point of entry, the only checkpoint still functioning since Guinea was declared free of Ebola.

IOM also revived the operational cross-border cooperation between Forecariah (Guinea) and Kambia (Sierra Leone) to share key information about the cases and their contacts, enhance the synergy of strategies being implemented on both sides of the border, and reactivate health screening points at major points of entry along Guinea’s borders with Sierra Leone.

“IOM and partners began by strengthening the main point of entry of Pamelap and by the end of the month, community volunteers will be deployed to perform health screening at 48 major points of entry, official and unofficial, with an average of more than 20 people crossing per day,” said IOM Guinea Chief of Mission Kabla Amihere.

This will complement the implementation of community event-based surveillance as part of post-Ebola health surveillance strengthening efforts.

“The government of Guinea is now working on the third phase of the Ebola response, which includes sensitizing communities to be more vigilant to prevent any resurgence of the epidemic and involving them in community event-based surveillance,” adds Amihere.

By 27th January, all IOM, ACF, CU, IFRC and GRC health screening supervisors, together with 122 volunteers, will be trained, equipped and deployed at the designated Points of Entry.

The volunteers will benefit from the support of Community Health Workers currently being trained and deployed by the same partners in Forecariah, all of whom will be responsible for identifying and communicating alerts to the surveillance unit.

With the support of the Office of US Foreign Disaster Assistance, the US Centers for Disease Control, Japan and Belgium, IOM Guinea has been providing logistics support to the Guinean government through the National/Prefectural Emergency Coordination programme.

IOM has also implemented activities to strengthen monitoring mechanisms at borders through a Health, Border and Mobility Management programme and other community mobilization activities in key villages to enforce epidemiologic surveillance for early detection of Ebola and other potentially epidemic diseases in border and maritime zones.

According to latest information from the National Coordination office, there have been 3,804 confirmed, probable, and suspected Ebola cases in Guinea since the beginning of the epidemic, including 2,536 deaths. These figures yield an estimated mortality rate of 66.7 per cent.

REPORTING PERIOD 14 - 20 Jan 2016

1. Highlights

• Flow Monitoring: As of 18 January 2016 IOM field staff in Greece, fYROM, Croatia, and Slovenia had amassed interviews with over 2,700 migrants and asylum seekers. Individuals of Syrian, Afghan, Iraqi,
  Iranian and Pakistani nationalities comprised 93%.

• The Greek- fYROM borders have been closed since 19 January at 19:00. As a result, some migrants and asylum seekers have sought alternative routes away from the control of the authorities of the two countries. To read more go to page 11. For developments on the Slovenian-Austrian border go to page 23.

• See sections on Greece and Italy for an update on the EU’s Relocations Plan.

• See the Special Features section for news about the route to Europe from Finland and Norway.

• On 06 January 2016 Germany’s Ministry of Interior announced that it had begun using a new system to count arrivals in 2015, rather than the asylum application system. The new numbers indicate that there may have been a larger overall number of arrivals to Europe in 2015 than has to date been detected in countries of transit. For a fuller explanation of this difference, please see page 36.

Two things immediately strike you when you arrive in the village of Thigbonor in Lokomasama chiefdom: the place is extremely tidy, and the high street is almost deserted. After a four hour drive from Sierra Leone’s capital, Freetown, we park under a large banana plant, and follow people’s indications to the outskirts of the village. I’ve been caught out before in West Africa when villagers promise “a short walk” under a hot sun, but in this case within two minutes the trees have given way to large open grassland and we quickly find much of the village digging, weeding and planting the rich brown soil.

If it wasn’t already apparent that this is one organised village, a cardboard sign next to the road spells out what’s going on. With the help of the men, women and youths actively at work, this patch of land is being transformed into a village okra and pepper garden under the guidance of the ‘VDC’ or Village Development Committee.

“This sort of VDC thing wasn’t existing before,” the village headman and chair of the VDC, Aboubakar Kamara, tells me during a short break from hoeing. He says it was during the Ebola outbreak, which was declared over on 7 November 2015, that the community started to work together.

This village of around 700 people was a hotspot for Ebola infections, with at least 25 confirmed deaths. During the quarantine period imposed on the village, crops ripening in the fields went to waste because villagers weren’t allowed to leave their homes.

Now, through the VDC, they are getting back on their feet. The villagers work together on Thursdays and Sundays to implement the community action plan they have drawn up, which is proudly displayed on a notice board in the centre of the village. Their initial priorities are the agricultural project to re-launch food production, a toilet block, and also a scheme to encourage the continual practice of hand-washing as a safe-guard against Ebola and other deadly diseases. Each home has a hands-free ‘tippy tap’ hand-washing station made within the village from a jerry can, string and a wooden frame.

Community groups – like development committees, neighbourhood watch groups, and village taskforces – were a key part of the successful response to the Ebola outbreak. The government and agencies like UNICEF hope to build upon the achievements of the past 18 months. Chiefdom and village development groups have existed in Sierra Leone in various forms since colonial times, though many are no longer in operation. A mapping exercise commissioned by UNICEF in 2015 found that 31 per cent of over 1,200 VDCs were active (meeting at least once a month) across the country.

A UNICEF partner in Port Loko district, OXFAM, is working to revive the VDCs as a way for communities to gain more control and say over their development. Each VDC has around 11-13 members including the village headman, a chairwoman, religious and traditional leaders, school teachers, health workers, and youth representatives.

“People here felt they were not considered,” says OXFAM’s chiefdom coordinator Mohamed Bangura. “They would go to sleep and the next day someone had built a toilet in the community without asking or informing anyone.” Now, the idea is that when development actors come into a village they will take account of the community’s own development plan rather than imposing a project without consultation.

A short drive away in the village of Kambia 1, another VDC has made the village’s main road a priority to boost local industry. As we arrive, the entire community appear to be armed with shovels and pickaxes as they work to improve the road.

The male youth representative on the Kambia 1 VDC, Abdul Majid Kamara, tells me the Ebola outbreak taught them what they could achieve as a team. “We mobilized all the youth to organise the community and protect our village from sick strangers,” he told me. “If we’ve now defeated Ebola, it’s thanks to our working together.”

A nearby school project shows the power of community mobilization. The village members decided to construct their own school building without waiting for support. Once the foundations were laid and the structure was three bricks high, they received the support of the local MP, and the building is now almost complete. The abrupt change in brick colour from the initial local construction is testament to how the community started the project themselves before it received backing from the authorities.

Back in Thigbonor village, just as I’m leaving, I meet 19-year-old Yeanor Kamara, who lost her father and mother to Ebola, which she recovered from herself.

“As a survivor, I am optimistic and glad about the Village Development Committee,” she told me. “The whole village has come together. There are some things that we can do ourselves. We continue washing hands because we don’t want Ebola to return. It doesn’t cost us a thing and it stops illnesses. But we’re only subsistence farmers so we can’t do everything.”

She adds as we head off. “I miss my family, but these things give me courage.”

John James is a Communications Specialist with UNICEF Sierra Leone

Freetown, Sierra Leone | AFP | Friday 1/22/2016 - 20:59 GMT |

A second new case of Ebola in Sierra Leone since west Africa celebrated the apparent end of the epidemic last week is responding well to treatment, an official said Friday.

The patient, the 38-year-old aunt of 22-year-old Marie Jalloh, who died of the disease on January 12, is "responding well to treatment" in a Freetown clinic, a ministry of health disease control official, Doctor Foday Dafai, said.

The official added authorities had yet to determine the origin of the new outbreak.

Dafai said the latest sufferer, who the World Health Organization told AFP on Thursday had been Jalloh's "primary caregiver," was in quarantine in the northern city of Magburaka when she tested positive and was transferred to the capital.

After visiting the woman, Dafai indicated that "121 contacts have been identified to have been exposed to the index case and 47 of them have been classified as high risk contacts" and so were under observation.

Given the potential for further infection he added "it is therefore very important that we quickly locate and isolate" anyone who may have had contact with the latest sufferer.

Dafai said a vaccination program for known contacts and overseen by chief medical officer Brima Kargbo was progressing satisfactorily," but urged anybody who may have been exposed to the virus to come forward.

"At the moment, we still don't know the source of infection in the first index case involving Marie Jalloh," Dafai said.

WHO spokesman Tarik Jasarevic told AFP on Thursday that 150 of Jalloh's contacts had been identified, "of which 42 are high risk."

Local people expressed concern over the potential further spread of a tropical virus which is at its most infectious as people are dying or in the bodies of those who have died from a virus which emerged in 2013 in southern Guinea.

"We never envisaged that the virus will return so soon just we were about to settle down after 18 months of enslavement," said 25-year-old taxi driver Osman Sesay.

A week ago, the WHO had announced transmission of the virus that killed 11,315 people and triggered a global health alert had ended, with Liberia the last country to get the all-clear.

Sierra Leone was declared free of Ebola transmission on November 7 last year and Guinea on December 29.

But officials warned that a recurrence remained possible and stressed the importance of a quick, effective response to potential new cases.

"Even though the cases occurred many miles away from the capital, we still cannot say we are safe because of the mode of human transmission," said Ibrahim Jallo, a timber merchant.

Traders say they fear the effect the latest cases may have on the economy.

Many pharmaceuticals firms said there has been a big run on dwindling stocks of hand sanitizer gels which manufacturers say kills 99.99 percent of germs and which were widely used in the first ebola outbreak.

rmj/cs/mrb/cw

© 1994-2016 Agence France-Presse

GA/11755

Seventieth Session,
83rd Meeting (AM)
GENERAL ASSEMBLY
MEETINGS COVERAGE

Initiative to Ensure Gemstones Catalyse Development, Not Civil War, Says Botswana Precious gemstones were meant for development, not catalysing civil war, the General Assembly heard today as it adopted a resolution recognizing the devastating human impact of conflicts fuelled by the trade in illicit diamonds, while reaffirming support for the Kimberley Process initiative aimed at halting their flow into legitimate markets.

Adopting the text without a vote, the Assembly stressed that the widest possible participation in the Kimberley Process Certification Scheme was essential. Calling upon participants to continue to articulate and improve rules and procedures so as to further enhance the Scheme’s effectiveness, the Council welcomed recent steps by the Mano River Union countries (Côte d’Ivoire, Guinea, Liberia and Sierra Leone) to generate a new impetus for further regional cooperation in terms of compliance with it.

By other terms of the resolution, the Assembly recognized the important contributions that international efforts to address the question of conflict diamonds had made to the settlement of conflicts and the consolidation of peace in Angola, Côte d’Ivoire, Liberia and Sierra Leone.

A joint initiative of Governments, the World Diamond Council, the industry umbrella group, and the Civil Society Coalition — established to prevent the flow of conflict diamonds into the legitimate international trade — the Kimberley Process aims to break the link between the illicit trade and armed conflict. The General Assembly, in resolution 55/56 of 2000, expressed the need for the creation of such a process and, by resolution 57/302, welcomed its launch in 2002.

Introducing today’s resolution, Bernardo Campos (Angola), Chair of the Kimberley Process, said it had demonstrated that “when Governments work together with the private sector and civil society organizations, they can ensure that the legitimate trade in diamonds helps countries reduce poverty”. The text reflected the substantial progress Kimberley had made in 2015, addressing the need to break the link between the illicit trade in rough diamonds and armed conflict.

Based on resolution 69/136 and the communiqué adopted at the Kimberley Process plenary meeting on 20 November 2015, he said, the text welcomed proposals for an international certification scheme for rough diamonds that could help to ensure implementation of Security Council sanctions on the trade in conflict diamonds. It also increased the accuracy of statistics, promoted prerequisites for cross-border Internet sales, and broadened involvement by Governments, regional groups, the diamond industry and civil society. In recent years, the Kimberley Process had made significant strides in fulfilling its mandate, he said.

Noting that the United Arab Emirates had been elected Chair and Australia Vice-Chair for 2016, he said that, since the lifting of the embargo imposed under Security Council resolution 2153 (2014), the Monitoring Team led by Angola had carried out a review visit to Côte d’Ivoire, which allowed that country to resume its export of rough diamond. Similarly, a review mission to the Central African Republic had enabled the resumption of rough diamond exports from compliance zones in July 2015. Those two steps represented tremendous progress towards allowing the marketing of legally exploited diamonds, he said, adding that, as of 1 December 2015, the Kimberley Process had 54 participants representing 81 countries, including 28 member States of the European Union.

Antonio Parenti, Head of the Economic, Trade and Development Section of the European Union, said that, as Chair of the Working Group on Monitoring, his delegation had helped to strengthen implementation of the Kimberley Process Certification Scheme, encouraging the continuing commitment of participants to peer-review visits and substantive annual reports. He called for all participants to host a review visit every three years. He welcomed the commitment by participants to consider recommendations contained in the report of the Financial Action Task Force relating to risks in the diamond supply chain. It also welcomed efforts by the Central African Republic to implement its work plan and road map for enhancing internal control systems, as well as steps by the Mano River Union countries relating to regional cooperation to ensure compliance with the certification scheme.

David Roet (Israel), noting that the “dark underworld” of the diamond industry had operated in the shadows, recalled that, 12 years ago, the atrocities stemming from the illegal diamond trade had led the international community to establish a unique scheme requiring States to regulate production and trade. Recent years had seen numerous achievements, and thanks to concerted global commitment, 99 per cent of all diamonds sold today were certified “conflict-free”, he said. As the world’s leading exporter of diamonds and third largest trading centre, Israel had been among the first to raise awareness. Reaffirming the importance of Kimberley’s tripartite nature, he emphasized that civil society must be fully involved, particularly in monitoring implementation.

Nkoloi Nkoloi (Botswana), noting that his country was a founding member of Kimberley, stressed the importance of ethical trade in rough diamonds. Members were required to uphold high standards in certifying that shipments entering and exiting their territories were legitimate. They were required to put national legislation in place, as well as export, import and internal controls, in addition to making a commitment to transparency. With a view to harnessing its national capacity by ethical means, Botswana believed in “doing good for the good of its people”, he said. It was committed to safeguarding the integrity of the diamond industry because diamonds accounted for 40 per cent of Government revenues. The Kimberley Process would work to ensure that diamonds were a source of economic development rather than a catalyst for civil war.

Suood Rashed Ali Alwali Almazrouei (United Arab Emirates) said his Government had joined the consensus on the resolution, which marked an important step in enhancing the Kimberley Process. Welcoming his country’s having been chosen as Chair of the Kimberley in 2016, the first Arab country to have achieved that honour, he said it had implemented the Process since 2003, another Arab “first”. It had adopted a law on the import and export of rough diamonds, as well as other regulations that had made the United Arab Emirates a leading centre for the legal diamond trade. As the 2016 President, it looked forward to sharing its expertise and would propose ideas for enhancing cooperation among all stakeholders, he stressed, adding that, among other things, it planned to host Kimberley Process members at various conferences in Dubai to discuss its upgraded infrastructure.

For information media. Not an official record.

AG/11755

Soixante-dixième session,
83e séance plénière - matin
ASSEMBLÉE GÉNÉRALE
COUVERTURE DES RÉUNIONS

L’Assemblée générale a réaffirmé, aujourd’hui, son engagement « ferme » et « constant » au Système de certification international du Processus de Kimberley et à l’ensemble de ce Processus qui a pour objectif premier d’exclure du commerce légitime les « diamants de la guerre ».

Dans une résolution* adoptée ce matin sans vote, les États Membres se disent conscients, en effet, que le Processus de Kimberly a permis, ces 13 dernières années, d’endiguer le flux de « diamants de la guerre » et qu’il a été un important facteur de développement permettant d’améliorer les conditions de vie des populations qui dépendent du commerce des diamants.

L’Assemblée générale considère, par ailleurs, que le Système de certification du Processus de Kimberley, qui est entré en vigueur le 1er janvier 2003, facilite l’application effective des résolutions du Conseil de sécurité imposant des sanctions contre ceux qui se livrent au négoce des « diamants de la guerre » et contribue à prévenir les conflits alimentés par le trafic de diamants.

Elle demande à ce que les mesures déjà adoptées par le Conseil de sécurité pour réprimer le commerce illicite de diamants bruts soient intégralement appliquées.

Les diamants des conflits, également dénommés « diamants du sang » ou « diamants de la guerre », sont des diamants bruts utilisés par les mouvements rebelles ou leurs alliés afin de financer des conflits armés visant à déstabiliser des gouvernements légitimes. Dans sa résolution, l’Assemblée générale se dit consciente que les initiatives engagées à l’échelle internationale pour résoudre le problème des « diamants de la guerre » ont fortement contribué au règlement des conflits et à la consolidation de la paix en Angola, en Côte d’Ivoire, au Libéria et en Sierra Leone.

Les efforts en cours n’empêchent pas certaines difficultés, a reconnu le Président du Processus de Kimberley. M. Bernardo Campos, de l’Angola, a réclamé un engagement inlassable des gouvernements, de l’industrie du diamant et de la société civile pour renforcer le système de contrôle et d’éradication du négoce illicite. « En 2003, à Kimberley, en Afrique du Sud, la communauté internationale a créé un système tripartite sans précédent », a rappelé M. Campos qui présentait le rapport 2015 du Processus de Kimberley** et la résolution.

Le Président du Processus a fait part de progrès importants réalisés, l’an dernier, notamment en matière d’amélioration de ses règles et procédures et de visites d’examen par les pairs effectuées dans les pays participants. Au 1er décembre 2015, le Processus de Kimberley comptait 54 participants, représentant 81 pays, dont l’Union européenne et ses 28 États, comptée comme un seul participant. Le Conseil mondial du diamant, qui représente l'industrie internationale du diamant, ainsi que des organisations de la société civile y jouent un rôle important depuis sa création.

En 2015, des visites d’examen ont été menées en Arménie, en République démocratique du Congo, en Côte d’Ivoire, dans les Émirats arabes unis, au Mexique, au Swaziland et dans l’Union européenne. En Côte d’Ivoire, une visite effectuée après la levée des embargos sur les armes légères et sur les diamants, conformément à la résolution 2153 (2014) du Conseil de sécurité, a permis la reprise des exportations des diamants bruts, s’est félicité M Campos. En outre, des pays continuent de rejoindre le Processus, a-t-il précisé. L’an dernier, le Mozambique, le Gabon et le Liechtenstein ont présenté leur candidature.

L’Union européenne a salué ces résultats. En tant que Présidente du Groupe de travail chargé du suivi du Processus de Kimberley, elle s’est félicitée des visites d’examen par les pairs mais a toutefois invité l’ensemble des participants au Processus à continuer de renforcer les mesures de suivi à travers le système des visites. Les participants doivent accueillir une visite d’examen tous les trois ans, a rappelé l’Union européenne.

Premier pays exportateur mondial de diamants et troisième plus grand centre de commerce du diamant, Israël a estimé que les avancées représentaient un « accomplissement extraordinaire ». Il y a 12 ans, le monde s’est élevé unanimement contre les « diamants de la guerre », a-t-il rappelé, avant de saluer les étapes qui ont suivi la mise en place de ce système de certification, notamment le renforcement du système d’examen par les pairs, une meilleure transparence et une précision dans les statistiques.

Israël a ensuite souligné combien le Processus de Kimberley contribue aussi, aujourd’hui, à la promotion du Programme de développement durable à l’horizon 2030. « Le résultat de l’engagement mondial concerté et des mesures qui ont été prises font que 99% de tous les diamants vendus aujourd’hui ne sont pas issus de conflits. Cela permet aux revenus tirés de ce commerce de contribuer à la croissance économique et au développement durable », a-t-il insisté.

Rappelant l’importance de la nature tripartite du Processus de Kimberley, il a suggéré un renforcement de la collaboration avec l’industrie diamantaire, les organisations internationales et les agences d’exécution.

Membre fondateur du Processus de Kimberley et pays dépendant de cette pierre précieuse, le Botswana a dit attacher une importance particulière à l’exploitation éthique et au commerce légitime des diamants bruts. Il a énuméré certaines des exigences minimales auxquelles doivent répondre les participants du Processus de Kimberley, notamment la législation adéquate et un système de contrôle interne. Il a, à son tour, jugé essentiel de promouvoir un commerce du diamant qui participe au développement social et économique. « L’industrie du diamant représente 40% de nos revenus », a-t-il dit, et chaque diamant vendu signifie qu’il y aura de la nourriture sur la table, de meilleures conditions de vie, des soins de santé, de l’eau potable, davantage de routes et plus encore.

Pour les Émirats arabes unis, Président du Processus en 2016, la loi nationale sur le contrôle des importations et des exportations de diamants bruts a conduit à d’autres règlementations qui ont fait du pays un véritable centre de contrôle du commerce de diamants. Il a dit vouloir proposer de nouvelles initiatives et idées pour garantir encore plus la légitimité et la légalité du commerce du diamant, souhaitant aussi organiser, en 2016, de nombreuses réunions et des séminaires à cet effet.

En début de séance, l’Assemblée générale a pris note d’une lettre*** contenant la liste des 15 États Membres actuellement en retard dans le paiement de leurs contributions au sens de l’Article 19 de la Charte des Nations Unies, qui sont les suivants: Bahreïn, Burundi, Comores, Guinée-Bissau, Îles Marshall, Libye, Mali, République dominicaine, République islamique d’Iran, Saint-Vincent-et-les Grenadines, Sao Tomé-et-Principe, Somalie, Vanuatu, Venezuela et Yémen.

Ces États ne peuvent pas participer au vote à l’Assemblée générale tant que le montant de leurs arriérés est égal ou supérieur à la contribution qu’ils doivent pour les deux années complètes écoulées, à l’exception des Comores, de la Guinée-Bissau, de Sao Tomé-et-Principe, de la Somalie et du Yémen que l’Assemblée a précédemment autorisés, par sa résolution 70/2, à participer à ses votes jusqu’à la fin de sa soixante-dixième session, en application de la dérogation prévue à l’Article 19.

*A/70/L.40
**Note verbale de la Mission permanente de l’Angola transmettant le rapport du Processus de Kimberley (A/70/596)
***A/70/722

The World Health Organization confirmed a new case of Ebola in Sierra Leone Thursday, the second since West Africa celebrated the end of the epidemic last week.

By Ryan Lenora Brown, Correspondent Silas Gbandia, Contributor

FREETOWN, SIERRA LEONE; AND JOHANNESBURG, SOUTH AFRICA — The story of Marie Jalloh’s death weeks ago sounds like it was plucked straight from the earliest days of Sierra Leone’s 2014 Ebola outbreak. In early January, family members brought the young woman to the government hospital in the northern town of Magburaka. A nurse without protective clothing took a blood sample, and later, Ms. Jalloh was discharged.

Read the full story on the Christian Science Monitor.

1. Introduction

Background

The outbreak of Ebola virus disease (EVD) that began in 2013 in West Africa had by December 2015, resulted in over 28,000 cases. Although estimates of the number of people affected during the outbreak vary, up to 10,000 EVD survivors may require convalescent care. A number of both short- and long-term medical problems have been reported in EVD survivors, including mental health issues for both survivors and other family and community members (1-19). In addition, increasing recognition that Ebola virus may persist in selected body compartments of EVD survivors, most notably in the semen of males, brings awareness of the possibility of reintroduction of the virus in areas where transmission has previously been eliminated.

EVD survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the risk of continued Ebola virus transmission, especially from sexual transmission. This document provides guidance on providing the necessary care and services for clinical care and virus testing, and should be used to guide the planning and delivery of ongoing health services to people who have recovered from EVD.

Target audience

The primary audience for this guidance includes health care professionals providing primary care to people who have recovered from EVD. This guidance may also be used by family or community members providing support and care to EVD survivors, as well as planners of health care services and policy makers.

Guidance development methods

This guidance was developed by the World Health Organization, Geneva, with inputs and feedback requested from stakeholders including Ministries of Health in Guinea, Liberia, and Sierra Leone; members of the UN Global Ebola Response Coalition; WHO country offices; research and non-governmental health organizations with recognized expertise and interest in the care of EVD survivors (Médecins-SansFrontières;

Centers for Disease Control and Prevention (CDC), Atlanta (United States of America); US National Institutes of Health, Bethesda (United States of America); Partners in Health, Boston (United States of America); GOAL, Dublin (Ireland)) and other stakeholders.

Due to the severe limitations of the existing scientific evidence base on clinical care for EVD survivors and the urgent need for guidance on this topic, the recommendations in this document have been developed from consensus expert opinion amongst the stakeholders consulted. Although this severely limits the scientific robustness of the guidance, the document still remains a representation of best available practice and will be reviewed as new evidence comes to light.

The unprecedented scale of the West African EVD outbreak that began in 2013 has resulted in many more survivors and thus opportunities to vastly enhance clinical observations and understanding of the many health challenges they face. New findings also come from clinical observations made on the 27 patients with EVD seen in high-resource settings in Europe and North America, where available medical technology often permits more detailed and comprehensive investigation. New presentations and complications of EVD are discovered on almost a weekly basis and new findings continue to be anticipated as capacity to care for EVD survivors in West Africa continues to grow.

WHO will continue to follow the research developments in the area of EVD and health outcomes for survivors, particularly those related to areas where new recommendations or a change in this guidance may be warranted.

Current epidemiological situation + country-specific information

The second week of January 2016 marked the first time since the beginning of the Ebola epidemic in West Africa when all three of the worst-hit countries had gone 42 days without a single new case. Yet the next day, another case was reported in Sierra Leone.

According to the WHO Ebola Situation Report of 20 January 2016, human-tohuman transmission directly linked to the 2014 Ebola Virus Disease (EVD) outbreak in West Africa was declared to have ended in Sierra Leone on 7 November 2015.

The country then entered a 90-day period of enhanced surveillance to ensure the rapid detection of any further cases that might arise as a result of a missed transmission chain, reintroduction from an animal reservoir, importation from an area of active transmission, or reemergence of virus that had persisted in a survivor.

On 14 January 2016, 68 days into the 90-day surveillance period, a new confirmed case of EVD was reported in Sierra Leone after a post-mortem swab collected from a deceased 22-year-old woman tested positive for the EVD. The woman died at her family home in the town of Magburaka, Tonkolili district, and received an unsafe burial. In the preceding 2 weeks the woman travelled from Port Loko, where she was a student, via the districts of Kambia and Bombali before arriving in Magburaka on 7 January.

Reports indicate that her symptoms during travel included vomiting and diarrhoea. The Sierra Leone Ministry of Health and Sanitation (MoHS), with the support of WHO and other partners, responded rapidly to the new case, identifying approximately 150 contacts of whom approximately 50 are deemed to be at high risk. Vaccination of contacts and contacts of contacts is underway under the authority and coordination of the Sierra Leone MoHS. However, the woman’s extensive travel history in the 2 weeks prior to her death, her presentation to and subsequent discharge from a health care facility at which health workers did not use Personal Protective Equipment (PPE), her period of close contact with family whilst ill, and her unsafe burial indicate a significant risk of further transmission. One contact in Tonkolili remains to be traced. The origin of infection is under investigation. A second case of Ebola has since emerged in Sierra Leone with a close relative of the first victim testing positive.

For more than a year, Liberia, Guinea, and Sierra Leone have been experiencing the largest outbreak of Ebola in history. Although Liberia was declared free of Ebola transmission on September 2, 2015, a new cluster of Ebola cases was confirmed in late November 2015 in Paynesville, a suburb of Monrovia. The health system in Liberia continues to monitor for new cases and to take precautions to prevent transmission in the country. IFRC and the RCRC partners are also closely monitoring the situation.

On 29 December, WHO declared that human-to-human transmission of the Ebola virus has ended in Guinea after the completion of 42 days with zero cases since the last person confirmed to have EVD received a second consecutive negative blood test for the Ebola virus RNA. Guinea has now entered a 90-day period of heightened surveillance. The last known positive patient was discharged from the ETC on 16 November 2015. After the last case detected in Sierra Leone, the Government has strengthened surveillance mechanisms in cross-border areas with Sierra Leone.

• UNHRD continues to dispatch operational equipment for its Partners, most recently supporting WHO and WFP by sending plastic pallets and vehicles to Guinea and Liberia.

• 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.

The following syndromes have been flagged:

Acute Fever and Rash: French Polynesia, Palau

Diarrhoea: Solomon Islands

Other updates

Dengue:

Fiji: 55 confirmed cases have been reported since the beginning of the year with the highest number from the Northern Division. Source: Fiji One TV Papua New Guinea: There is currently a dengue outbreak ongoing. A total of 170 cases were seen at the Daru [an island on the southern tip of Western Province, along the Torres Strait that bridges between PNG and Australia] 4th of November to the 8th of January 2016. For further details please refer to Dr Boris Pavlin’s PacNet post on 20 January 2016.

Diarrhoea

Solomon Islands: Rotavirus outbreak continues. A positive downward trend in case numbers has been observed for week ending 17 January 2016 with 5 additional deaths for investigation. This brings the total number of deaths reported during the outbreak to 17.

Ebola Virus Disease (EVD)

Health officials in Sierra Leone have confirmed a death from EVD, hours after the West Africa outbreak was declared over. WHO has stressed in a statement on 14 January, that Guinea, Liberia and Sierra Leone remain at high risk of additional small outbreaks of EVD in the coming months due to the virus persisting in survivors after recovery.

Zika virus – microcephaly

Brazil: As of epidemiological week 1 of 2016, there were 3,530 microcephaly cases recorded, including 46 deaths, in 20 states and the Federal District. in Currently there is only ecological evidence of an association between increased microcephaly, neurological and autoimmune syndromes, and prior infection with Zika virus; the possible causative nature of the association cannot be ruled out with the evidence available. Source: PAHO

Hawaii: Recently a newborn was born with microcephaly. The Hawaii state Department of Health said the baby's mother likely contracted Zika virus while living in Brazil last year and passed it on while her child was in the womb.

Report by the Director-General to the Executive Board at its 137th Session

Geneva, Switzerland, 25 January 2016

Madam Chair, distinguished members of the Executive Board, Excellencies, colleagues in the UN system, ladies and gentlemen,

Fifteen months ago, Guinea, Liberia, and Sierra Leone were together reporting more than 950 cases of Ebola every week. Today, the three countries have interrupted all chains of transmission from the original outbreak that began more than two years ago.

This is a monumental achievement that needs to be acknowledged. Please join me in honouring the leadership of the three governments, the heroic sacrifices of health care workers and communities, and the unwavering support from a host of partners.

However, WHO has not yet declared the outbreak in West Africa over. As we now know, the virus can hide in the bodies of fully recovered survivors for as long as a year.

Since March of last year, WHO has documented 11 small flare-ups of infection following reintroduction of the virus from survivors. All were rapidly detected and quickly contained.

On 14 January, WHO declared that the outbreak in Liberia, the last country reporting cases, was over, but warned that the risk of further flare-ups would persist. The warning was well-founded. The next day, Sierra Leone confirmed its first new case since September of last year.

Let me put this setback in perspective.

First, these countries promptly report new cases. Vigilance is intense. Our view of the situation is sharp and transparent.

Second, these countries have the world’s largest pool of expertise in responding to Ebola. They know exactly what to do.

Third, I still have more than 1000 staff in West Africa to assist in detecting and responding to flare-ups like this one. I thank them for their skill and dedication.

Finally, thanks to a WHO-led clinical trial, we have a vaccine that can be used to confer a back-up ring of protection.

The Ebola virus is stubborn. I have no doubt that further flare-ups will occur. I have no doubt that all will be quickly contained.

The outbreak lingers in a second sense as well. Well over 10,000 survivors face persistent health problems together with continuing stigmatization. They need care.

Ebola delivered an extremely severe and shattering blow to societies and economies. Recovery will take some time.

While the job is by no means finished, no one anticipates that the situation will return to what we were seeing 15 months ago.

The determination is fierce. International solidarity has been extraordinary. The many steps taken at national and international levels have had a decisive impact.

No one will let this virus take off and run away again.

In the wake of Ebola, health officials are more alert to alarming signals coming from the microbial world.

Last year’s MERS outbreak in the Republic of Korea showed the devastation a new disease can cause, even in a country with an advanced health system.

The explosive spread of Zika virus to new geographical areas, with little population immunity, is another cause for concern, especially given the possible link between infection during pregnancy and babies born with small heads.

Although a causal link between Zika infection in pregnancy and microcephaly has not been established, the circumstantial evidence is suggestive and extremely worrisome. An increased occurrence of neurological syndromes, noted in some countries coincident with arrival of the virus, adds to the concern.

I thank all newly affected countries for detecting the virus quickly, and promptly and transparently notifying WHO in line with the International Health Regulations.

I have asked Dr Carissa Etienne to brief the Board later this week on the current Zika situation and our response.

Yet another alarming signal was China’s detection last year, in animal and human samples, of a mechanism of drug resistance, involving the mcr-1 gene, that is easily transferred from one bacterial strain to others, including some with epidemic potential.

That finding, which raised the spectre of bacteria that are resistant to nearly all antibiotics, has since been replicated in several other countries.

Ladies and gentlemen,

In my address to last year’s Health Assembly, I announced my intention to create a new programme for responding to outbreaks and humanitarian emergencies.

I expressed my desire to design the programme for effectiveness, speed, flexibility, and rapid impact, with administrative procedures and business processes fit to support its operational platform.

In July, I appointed a group of very senior experts to advise me on the programme’s functions, structure, administration, and lines of managerial accountability. The advisory group provided this guidance with great diligence, and in great detail. The group was frank, critical, and thorough.

The experts looked at all independent assessments of the Ebola response issued to date and analysed the experiences of some effective emergency operations, like those run by the World Food Programme and UNICEF.

The group held eight meetings, beginning in July, and delivered its final report to me last week.

The experts in the advisory group called for profound transformational changes in the way we respond to outbreaks and emergencies.

This is what was needed. This is what I wanted. This is what is widely regarded as the right direction to take.

Let me reassure you, our Member States, that the Regional Directors and I are determined to change the way we respond to outbreaks and emergencies. The lessons from Ebola must be applied.

We are committed to implementing a single programme, with a single line of accountability, a single budget, a single set of business processes, a single cadre of staff, and a single set of performance benchmarks that cut across all three levels of WHO.

These changes will make WHO much stronger, at all levels, in supporting countries and building national and global capacity to prevent, detect, and respond to emergencies with health consequences.

The new programme for health emergency management will have an operational arm, complementing WHO’s established functions in setting norms and standards.

As with outbreaks, the complexity of humanitarian emergencies underscores the need for transformational changes in our response capacity.

Ongoing armed conflicts and protracted crises have left an unprecedented 77 million people in urgent need of essential health care. Some 60 million of these people have been uprooted from their homes, the largest number since the Second World War.

Their health expectations are not high. They just want to survive.

I join others in deploring the attacks on health care workers and facilities that are becoming almost routine in the Middle East, including the recent bombing of a polio vaccination centre in Pakistan.

I join others, including the UN Secretary-General, in deploring the use of siege tactics as a method of warfare. Such tactics target civilians and violate international humanitarian law.

Has the world lost its moral compass? Even wars have laws. Forcing civilians to starve to death breaks those laws.

On the positive side, the world showed its solidarity before a shared threat last December in Paris, when 195 countries adopted a climate treaty. But more needs to be done to address the root causes of other crises that profoundly threaten health.

It is easier to deliver humanitarian assistance than to work out political solutions to the root causes of protracted conflict, violent extremism, terrorism, and the forced displacement of millions.

The world has rallied in support, delivering unprecedented levels of humanitarian assistance. But the costs of doing so are unsustainable.

Ebola taught the world that an outbreak in any part of the world can have global repercussions. The refugee crisis in Europe taught the world that wars in faraway places will not stay remote.

In a profoundly interconnected world, there is no such thing as a local outbreak. There is no such thing as a faraway war. As some assessments of the Ebola response have concluded, having strong public health infrastructures and capabilities in place in vulnerable countries is the first line of defence against the infectious disease threat.

Universal health coverage, based on the principles of primary health care, is an instrument for improving the resilience of health systems and the resilience of communities. It tackles the root causes of conditions that let outbreaks hide undetected for months and run out of control.

Universal health coverage is also the most efficient way to respond to the rise of noncommunicable diseases. It is a pillar of sustainable development that supports multiple goals and targets in the 2030 development agenda.

Development that is inclusive and sustainable is by far the best way to build resilience to the shocks our world keeps delivering with ever-greater force.

Ladies and gentlemen,

The Sustainable Development Goals, the SDGs, respect the way that all dimensions of life on this planet shape human health. The agenda is unprecedented in its scope and breath-taking in its ambition.

Health is the focus of goal three, but multiple other goals and targets address the social, economic, and environmental determinants of health.

The thirteen targets under the health goal continue the unfinished business of the Millennium Development Goals and respond to some additional health threats, namely NCDs and mental health, substance abuse, road traffic crashes, and hazardous environmental chemicals.

The inclusion of universal health coverage is the target that underpins all others and is key to their achievement. Health benefits greatly from the agenda’s broad and integrated approach, especially when it comes to the target set for NCDs.

The SDGs easily accommodate recent global strategies and plans of action approved by our Member States. In fact, all 13 health targets are reflected in your agenda for this EB session.

However, the new agenda has profound implications for the way WHO operates, not supplying health services but delivering what countries and their people need and expect.

The SDGs call for stronger country offices, a firm emphasis on innovation, and greater collaboration with partners and multiple sectors of government.

Our programmes that contributed so much to the MDGs for reducing maternal and child mortality, and turning around the epidemics of HIV, tuberculosis, malaria, and the neglected tropical diseases are mature.

They are well-placed to support even more ambitious targets, aligned with the SDG principles of integrated and inclusive approaches that deliver country-level results.

The culture of measurement and accountability, introduced during the MDG era, will continue. Determination to address the health needs of women and adolescents is strong.

Initiatives for the eradication of polio and guinea worm disease have moved forward greatly over the past year. These efforts must continue.

Ladies and gentlemen,

The future is clouded by some major threats to health that encircle the globe. They define some top priorities for urgent and collaborative action in the months ahead.

The volatile microbial world is an ever-present threat. As underscored during last year’s Health Assembly, too many countries lack the core capacities needed to implement the International Health Regulations.

This must change. These countries must be supported to build IHR core capacities to prevent, detect, and respond to outbreaks.

The Global Policy Group has endorsed the Joint External Evaluation tool for the assessment of gaps so that technical support to the countries, from WHO and partners, can be provided.

Noncommunicable diseases are a growing threat with major risk factors that can be modified. Later today, the Commission on Ending Childhood Obesity will present its final report to me.

The report uses the latest cutting-edge science to deliver a series of policy recommendations with teeth. Implementing the recommendations will take political will, and courage, as some go against the interests of powerful economic operators.

Antimicrobial resistance is a danger of the utmost urgency. This year will be a pivotal one, culminating in a UN high level meeting on AMR later this year. We have a global action plan. What we need now is the action.

A top priority is to fully engage ministers responsible for agriculture and food. We will explore ways to do so during next month’s European Union ministerial conference on antimicrobial resistance in Amsterdam.

Climate change is another defining issue for health. While the Paris climate accord is a most welcome step forward, it will not prevent a number of immediate and severe health consequences.

We need to sharpen our programmes for dealing with these consequences, like outbreaks of cholera and dengue, the disruptions in food security that follow droughts and floods, the ill health linked to indoor and outdoor pollution, and the need for emergency assistance following extreme weather events.

The priority dearest to my heart is, of course, universal health coverage. Packed into that commitment are a host of issues that are important for you and all Member States: like access to safe and effective medicines, an adequate health workforce, finding ways to make health products more affordable, and the challenge of caring for ageing populations, especially people with dementia.

By stressing people instead of diseases, universal health coverage provides a much needed, compassionate, and more responsive platform for delivering coherent and integrated health services. By honouring the human right to health, and providing protection against financial ruin, it helps alleviate the root cause of significant human misery.

It embodies that commitment to fairness that I believe is at the heart of what WHO does best.

We must always remember the people. People seeing their families and communities devastated by an outbreak. Children trapped in obesogenic environments.

People with a common infection whose doctors say, “Sorry, there is nothing I can do.” People forced to leave their homes by war or weather.

People driven into poverty by the costs of a disease like cancer or a car crash.

These are the people, and their needs, that must drive our commitment.

Thank you.

25/01/2016

The outbreak of the Ebola Virus Disease has a multi-sectoral adverse impact in Sierra Leone, including on agriculture, which is one of the major income generating sector in the country. The outbreak caused the disruption of farming activities, the closure of periodic markets, price volatility, and the depletion of revolving funds of individual farmers and groups.

In the framework of its support to the government of Sierra Leone, FAO received timely financing from the Africa Solidarity Trust Fund (ASTF) to mitigate the negative effects of the outbreak on farmers’ livelihoods. Together with the Ministry of Agriculture, Forestry and Food Security (MAFFS), FAO is supporting sixteen Agriculture Business Centres (ABCs), comprising 3 000 farming households that benefitted from cash transfers based on actual needs. This support has enabled farmers to reactivate their village savings and revolving funds, increase their productivity, purchase desired agricultural inputs and invest in their productive capital.

During an FAO four-day tour in farming communities in the East, North and South of the country, beneficiaries of the Ebola recovery support gave testimonies of how the support have capacitated them to recover from the devastating effects of the outbreak.

The Tawopanneh Agriculture Business Centre (ABC) located in Kamaranka Town in Bombali District, benefitted from USD 7500 based on their recovery need. The ABC comprises two farmer-based organizations (FBOs) with 100 members engaged in rice and groundnut farming. Its main source of income is the buying and selling of agricultural inputs to individual farmers and organizations in the district.

According to the Chairlady, Salamatu Bangura, members of the Centre were preparing for harvest when the disease breakout in their community. In 2015they didn’t harvest the forty-five acres of groundnut and inland valley swamp rice fields because of panic, quarantine measures and movement restrictions. “The poor yield and market disruption prevented the Centre from meeting the demands of its customers” she lamented.

With the ASTF support, the Centre is now capacitated to buy farming inputs and agricultural products again, and at higher levels than during the previous years when businesses were normal. At the time of the FAO visit, the Centre had established a seed bank including groundnut seeds, and stocks of rice and beans were in place. Fertilizers and other agricultural inputs were being purchased in the capital Freetown. “We received the support at the time we needed it most because we were very worried that we could not meet the demand of our customers for this year. The fact that our revolving capital had been depleted because of market disruption was our major source of concern” she said.
The management of the Centre is expected to get more agricultural inputs against February 2016 as they have dished out cash to agents in the surrounding villages to buy on their behalf. Like the members of the Tawopanneh ABC, other beneficiaries of FAO cash transfers have used them to reactivate their village savings and revolving funds, increase productivity, procure desired agricultural inputs and increase investments.

It is expected that this assistance will have a multiplier effect on their communities as cash injected will boost economic activities and bring income to their homes.

A FUTURE FREE FROM FEAR

At MAG, we believe that whenever and wherever wars happen, ordinary people should not be the ones who pay the price.

As Chief Executive of the UK’s only aid and development charity to have shared the Nobel Peace Prize, I am immensely proud of the difference MAG and our donors made directly to the lives of more than 1.4 million men, women and children in 2015.

Together, we made around 33 million square metres of land (that’s more than 4,500 Wembley-stadium sized football pitches) safe from landmines and unexploded bombs, so that people can safely grow crops, walk to school, access water, get to market, and live without fear.

This is truly extraordinary and would not have been possible without the generosity of all those who supported our programmes in Africa, Central America, the Middle East and South East Asia.

Yet, whilst these numbers are important, on their own they do not do justice to the incredible impact of this work on lives and livelihoods. The stories we hear, some of which are within this summary, of people sleeping soundly at night, of no longer worrying about their children walking to school, of growing enough rice to send their sons and daughters to school and build a new home, of escaping fear and poverty… this is the real difference MAG makes around the world and what inspires us to do more.

We are painfully aware of just how much still needs to be done. Mines and unexploded bombs are not being cleared fast enough for those who still live around them, in fear, every day. These people must not be forgotten.

Sadly, new conflicts are also putting even more people at risk. The ongoing crisis in Syria, violence in Iraq and instability in South Sudan mean the need to help vulnerable people is as big as ever. The families who’ve fled their homes in fear for their lives are now finding themselves in danger from explosive weapons left over from old conflicts in neighbouring regions and countries. They need our help.

This is why we are determined to do more. And so, as we thank everyone who has been part of MAG’s achievements and work in 2015, we look forward to reaching even more people in 2016 – to give them back their future, free from fear and danger.

Thank you

Nick Roseveare
Chief Executive

1. Highlights

• Flow Monitoring: As of 18 January 2016 IOM field staff in Greece, fYROM, Croatia, and Slovenia had amassed interviews with over 2,700 migrants and asylum seekers. Individuals of Syrian, Afghan, Iraqi,
  Iranian and Pakistani nationalities comprised 93%.

• The Greek- fYROM borders have been closed since 19 January at 19:00. As a result, some migrants and asylum seekers have sought alternative routes away from the control of the authorities of the two countries. To read more go to page 11. For developments on the Slovenian-Austrian border go to page 23.

• See sections on Greece and Italy for an update on the EU’s Relocations Plan.

• See the Special Features section for news about the route to Europe from Finland and Norway.

• On 06 January 2016 Germany’s Ministry of Interior announced that it had begun using a new system to count arrivals in 2015, rather than the asylum application system. The new numbers indicate that there may have been a larger overall number of arrivals to Europe in 2015 than has to date been detected in countries of transit. For a fuller explanation of this difference, please see page 36.

Highlights

• The ET Cluster was demobilised from West Africa as of 31 December. In November, Sierra Leone became the first country where the ET Cluster demobilised followed by Guinea and Liberia on 31 December 2015.
• 9x sites across West Africa – 5x in Sierra Leone and 4x in Liberia- previously supported by the ET Cluster remain operational until the end of February 2016 and 6x sites – 1x in Sierra Leone and 5x in Guinea – will be operational until June 2016. These sites will be supported by local Information and Communications Technology (ICT) capacity.
• Rami Shakra, the regional ICT/ET Cluster operation and ICT/ ET Cluster coordinator in Liberia, left the West Africa operation on 10 January. The ICT/ ET Cluster coordinator in Guinea, Habib Shashati, left the country on 15 January.

Freetown, Sierra Leone | AFP | Tuesday 1/26/2016 - 22:01 GMT

Three youths were seriously injured in clashes with police in Sierra Leone Tuesday after authorities ordered village traders to shut up shop while they hunted for people who may have had contact with an Ebola victim, witnesses said.

Angry youths allegedly burnt down a police post in the northern village of Barmoi Luma, reports said, as police fired tear gas to disperse angry crowds.

Witnesses told AFP by telephone that three youths were seriously hurt, with one shot in the head and another in the leg.

Authorities said the trouble started Saturday when 30 local people were quarantined for having potentially had contact with Marie Jalloh, a 22-year-old who died of Ebola on January 12.

Some 50 others who may have come into contact with Jalloh went into hiding in the community, which is deeply suspicious of western treatments for the deadly virus.

A town chief told AFP that police in Barmoi Luma had ordered market traders to halt business and shops to close from Saturday "to minimise any risk of contact with the runaway contacts", and they had remained shuttered.

"This has angered residents who said the actions of the police were arbitrary since Marie Jalloh did not die in Barmoi Luma but in Magburaka," he said.

Health authorities believe Jalloh fell ill in Barmoi Luma before travelling to the city of Magburaka some 100 kilometres (62 miles) away.

Witness Fatu Jalloh told AFP: "Temper flared up this morning when the police tried to enforce the no-trading order and dozens of youths and women rushed into the streets, hurling sticks and stones at police search teams."

She added: "I saw seven people injured, three of them seriously... There were lots of tear gas smoke and people were dashing for cover."

Doctors at the Italian-run Emergency Hospital in the capital Freetown confirmed that three seriously injured patients had been brought from the area but declined to give further details.

Police have denied using live bullets to quell the disturbance.

Francis Hazeley, a local police commander, told reporters: "We did not use live shots but used tear gas canisters to disperse the protesters."

Reports said the area was now calm, with police withdrawing to the nearby town of Kambia on the request of community leaders.

Senior officials including Health Minister Abu Bakarr Fofonah and national police chief Francis Munu were holding urgent talks with local authorities in Kambia.

Jalloh's death came just a day after west Africa had celebrated the end of the Ebola epidemic which cost 11,000 lives.

Her aunt has since also been diagnosed with the virus, with an official saying Friday that she was responding well to treatment.

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