Freetown, Sierra Leone | AFP | Tuesday 2/9/2016 - 15:57 GMT

Sierra Leone's most recent case of Ebola has been cured, but more testing is required before the latest outbreak can be seen as resolved, health authorities said Tuesday.

"The last known Ebola patient in Sierra Leone, 38-year-old Memunatu Kalokoh, has been discharged from the 34 Military Hospital in the capital after two rigorous tests proved negative," Ministry of Health Director of Disease Prevention and Control Dr Foday Dafai told AFP.

Dafai added that Memunatu, discharged last Friday, was back in her central northern home district of Tonkolili.

Health ministry spokesman Sidi Yahya Tunis told state radio her discharge "means that Sierra Leone has again started the 42-day countdown" period towards what it hopes will be a renewed all-clear from the World Health Organization.

Memunatu was the primary carer of 22-year-old Marie Jalloh, who died of the disease on January 12 in the northern city of Magburaka, eight days before the former was diagnosed.

After visiting Memunatu just after she was diagnosed Dafai told reporters that 121 contacts had been identified as having been exposed, a third of them classed as high risk.

Stressing the importance of locating and isolating anyone who may have had contact with Memunatu, Dafai said at the time a vaccination programme for known contacts was progressing satisfactorily, while urging other potential contacts to come forward.

On Tuesday, Dafai said: "As I speak to you, everything is quiet on the Ebola front around the country."

Despite his optimism, however, health officials told AFP that only ten of 48 potential exposed contacts around the northern city of Kambia near the Guinean border have been traced to date.

Eighteen are thought to be high risk and officials urged them to report for precautionary testing.

They added that four contacts who were residing in the same quarantine zone as Memunatu when she became ill will remain under observation until Thursday, 21 days after their last possible exposure.

Sierra Leone was declared free of Ebola transmission on November 7 last year and Guinea on December 29 while Liberia followed on January 14 -- but only after the virus killed 11,315 people, according to WHO estimates, triggering a global health alert.

The WHO has been warning of the possibility of a recurrence and stressing the importance of a quick, effective response to potential new cases

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CONTEXTE

Dans le cadre de l’application du Règlement Sanitaire International (RSI), les pays sont tenus de déterminer rapidement les mesures de lutte nécessaires pour éviter la propagation des maladies aux niveaux national et international.
Les États parties au RSI doivent respecter (renforcer) les capacités requises en matière de santé publique dans les aéroports, ports et postes-frontières désignés en temps normal et lors d’événements pouvant constituer une urgence de santé publique de portée internationale (USPPI).

Dans le cadre de la déclaration de l’épidémie de maladie à virus Ebola (MVE) en Afrique de l'Ouest comme USPPI, le comité d’urgence de l’OMS avait indiqué que l’épidémie de MVE constituait un risque de santé publique pour les autres Etats et que les conséquences possibles d’une diffusion internationale de l’épidémie étaient importantes. La surveillance des mouvements de voyageurs au niveau des Points d’Entrée (PE) avait notamment été identifiée comme un défi majeur.

Le Gouvernement de la République de Guinée via la Cellule de Coordination Nationale de Lutte contre la maladie à virus Ebola (CNLEB) a mis en place un système de Points de Contrôle Sanitaire (PCS) au niveau des principaux PE du pays.

La surveillance sanitaire aux PE constitue une étape et une catégorie à part entière dans les niveaux de surveillance définis dans la stratégie décidée par le gouvernement et ses partenaires (national, régional, préfectoral, sous-préfectoral et communautaire).

La connaissance de l’importance des flux migratoires et la compréhension de la mobilité des populations sont d’une importance capitale dans la définition des interventions de surveillance des MPE au niveau des principaux PE et des zones frontalières.

METHODE

Avec le soutien d’OFDA-USAID (Office of U.S. Foreign Disaster Assistance – United States Agency for International Development) et du Gouvernement Japonais, l’Organisation Internationale pour les Migrations (OIM) renforce les mécanismes de surveillance au niveau des principaux PCS frontaliers depuis Juin 2015. Ce soutien dans la surveillance épidémiologique de la MVE aux frontières est mis en œuvre en partie à travers le déploiement d’agents de suivi des flux migratoires (agents FMP).
Les agents FMP Ebola travaillent en collaboration avec les agents de contrôle sanitaire qui assurent déjà la surveillance épidémiologique pour la détection précoce des cas de MVE (prise de température, recherche de signes cliniques correspondant à la définition d’un cas suspect de MVE et de notion de contact avec un cas de MVE dans les 21 jours précédents) et les agents des forces de sécurité déployés au niveau des PE.

Ils sont en charge du recueil des données démographiques sur les voyageurs (nom ; prénom ; âge ; sexe ; nationalité ; numéro d’immatriculation du véhicule ; durée du séjour ; raison du voyage ; informations détaillées sur la provenance et la destination : pays, région, préfecture/cercle, commune ; numéro de téléphone ou personne à contacter). Les données recueillies aux PCS sont envoyées régulièrement à Conakry ou synchronisées via le réseau internet pour la création d’une base de données de Suivi des Flux Migratoires dans le respect des règles de confidentialité. La base de données peut être utilisée pour la recherche et l’identification rapide des personnes ayant été en contact durant un voyage avec des cas suspects ou confirmés. Les modalités de partage de la base de données avec les autorités guinéennes sont en cours de finalisation. Les résultats font l’objet de rapports de situation réguliers des mouvements transfrontaliers utiles dans l’identification des zones à risque en Sierra Leone (en fonction des données épidémiologiques) et le dénombrement des zones les plus impactées par la migration en Guinée.

En cas d’alerte (hyperthermie et symptômes correspondant à la définition d’un cas suspect de MVE), les agents de contrôle sanitaire contactent les autorités médicales pour lancer la procédure de prise en charge du cas alerte.

• There are ten weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, an important milestone in achieving a polio-free world. Read more here.

• The WHO Executive Board met last week, recognising progress made in 2015 and renewing their commitment to polio eradication. Read more here.

• For the first time in history, Africa has had 4-months without any wild or circulating vaccine-derived poliovirus cases, nor any environmental positive sample.

ADVANCE UNEDITED COPY

Executive Summary

A. The Ebola Outbreak as a Wake-up Call

The 2014 Ebola outbreak was a human tragedy that took thousands of lives, caused tremendous suffering, and left deep wounds in communities in Guinea, Sierra Leone and Liberia. And yet, it was preventable. Much more could have been done to halt its spread earlier. The crisis must serve as a wake-up call for increased global action to prevent future health crises.

The multiple failures experienced during the Ebola response demonstrated that the world remains ill-prepared to address the threat posed by epidemics. A lack of basic surveillance capacities in West Africa meant that the virus initially spread undetected for three months. When recognized, the scale of the outbreak was underestimated by experts and minimized by authorities. Despite numerous warnings from groups including Médecins Sans Frontières (MSF), the governments of the three most-affected countries and the World Health Organization (WHO) maintained that the outbreak would soon be under control. It was not until 1,600 people had been infected and the epidemic was spiralling out of control that the WHO declared the Ebola outbreak to be a Public Health Emergency of International Concern (PHEIC), thereby attracting the world’s attention.

When the epidemic was recognized as a global threat, the world mobilized unprecedented resources and capacities, which included the deployment of foreign military assets and the decision by the Secretary-General to establish the first-ever UN health emergency mission. Nevertheless, the response was hampered by a lack of trained and experienced personnel willing to deploy to the affected countries, inadequate financial resources, a limited understanding of effective response methods, ineffective community engagement and poor coordination. As a result of these delays and failures, thousands of lives were lost.

More than two years after the first death from the epidemic, 11,316 people have been killed by the disease, and 28,638 infections have been reported.1 The epidemic also caused an estimated US$2.2 billion in economic losses in the most affected-countries, reversing hardwon progress towards the Millennium Development Goals (MDGs).

B. The global burden of communicable diseases

For centuries, the world has been subjected to epidemics and outbreaks with often devastating consequences. In 1918, a pandemic of H1N1 influenza killed an estimated 50 million people. Today, a number of other communicable diseases continue to claim millions of lives. Recent outbreaks of influenza (H1N1 and H5N1), Severe Acute Respiratory Syndrome (SARS) and Middle-East Respiratory Syndrome (MERS) have shown that even sophisticated health systems in developed countries can be challenged by the appearance of new or emergent pathogens.

Notwithstanding its devastating impact in West Africa, the Ebola virus is not the most virulent pathogen known to humanity. Mathematical modelling by the Bill and Melinda Gates Foundation has shown that a virulent strain of an airborne influenza virus could spread to all major global capitals within 60 days and kill more than 33 million people within 250 days.
Despite the significant threat, global efforts to prepare for epidemics have been woefully insufficient. The global legal instrument negotiated to ensure early warning and pandemic response, the International Health Regulations (2005) (IHR), has only been fully implemented by one-third of its 196 States Parties. Similarly, only a small fraction of global investment in Research and Development (R&D) for vaccines, therapeutics and diagnostics is devoted to the emerging communicable diseases that primarily affect the developing world.

C. A call for action

Future pandemic threats will emerge and have potentially devastating consequences.
We can either take immediate action to ensure that future threats are contained and humanity is protected, or we will remain vulnerable to losing millions of lives and suffering devastating social, political and economic consequences.

The Panel has made twenty-seven recommendations for action at the national, regional and international levels, including many measures that cut across governance levels and require engagement with all sectors of society. While complex, there are a few concrete actions that can be taken immediately that will involve partners from governments, international institutions, civil society, and the private sector all working together with a newfound urgency. These priority actions will begin to build the global capacity required to manage future health crises and accelerate the implementation of the Panel’s recommendations.

First, the WHO must build a new Centre for Emergency Preparedness and Response and ensure that the world has a standing capacity to immediately identify and respond to emerging communicable disease threats. The Centre must have real command and control capability, access to specialized human and operational resources to execute a health response, and the ability to visualize and share validated surveillance data in real-time. The Centre should benefit from the best technology available to ensure the global community can identify, track and respond effectively to any emerging threat.

Second, all countries must meet the full obligations of the IHR. Where capacities are lacking, support should be provided to urgently implement a core set of measures. These measures should be under the direct authority of the heads of government and should include the establishment of pandemic preparedness and response mechanisms, with clear command and control; hiring and training health professionals and community health workers; and building a comprehensive surveillance system with a national laboratory.

Third, appropriate financing is required. Assistance should be provided to countries requiring additional support for IHR compliance, while WHO and the new Centre for Emergency Preparedness and Response must be resourced to meet global needs. In addition, a fund should be established to support R&D for vaccines, therapeutics and diagnostics for neglected communicable diseases.

To ensure that key measures are taken, a central recommendation of the Panel’s work is to establish a High-level Council on Global Public Health Crises within the General Assembly to provide political leadership on global preparedness, monitor the implementation of reforms, and help prepare for a Summit on Global Public Health Crises in 2018.
The Ebola outbreak was a wake-up call. Global leaders must act now to implement the following recommendations.

D. Chapters

i. National level (see recommendations 1 to 4)

The local community is on the front-line of any outbreak, and the state is the primary actor responsible and accountable for issuing appropriate alerts and responding to a crisis. The local and national levels of the global health architecture require the development of foundational capabilities for effective preparedness and response.
The Ebola response demonstrated that the inadequate implementation of national obligations under the IHR, weak health systems, governance challenges, and poor engagement with communities hampered the ability of national authorities to stem the spread of the virus.

The following key measures are needed at the national level: Implement the IHR Core Capacities, build an effective health workforce, address governance challenges, improve community engagement, and address gender aspects of health crises.

ii. Regional and sub-regional level (see recommendation 5)

While regional and sub-regional organisations supported the Ebola crisis response with innovative and experienced capacities, a lack of preparedness and pre-existing arrangements contributed to response delays and coordination challenges.
Regional organizations should develop or strengthen standing capacities to assist in the prevention of and response to health crises, with particular emphasis on areas where they can add significant value to national responses.

iii. International level (see recommendations 6 to 9)

The Ebola crisis also highlighted critical gaps in the international system for responding to health crises. In particular, the mechanism for monitoring compliance with the IHR’s Core Capacity requirements is weak. The lack of independent assessments affects international efforts to support more vulnerable countries in implementing preparedness, surveillance, detection, and response capacities. In addition, the absence of a strong WHO response capacity and the lack of clarity over the inter-agency leadership and coordination arrangements for health crises delayed an effective response. This delay led the UN SecretaryGeneral to take the unprecedented decision to establish the first United Nations health emergency mission.
Urgent measures are needed to address these gaps and enhance global capacity to rapidly detect and respond to health crises. These include establishing a stronger periodic review of compliance with the IHR’s Core Capacity requirements, strengthening the WHO’s operational capacities, and enhancing the Inter-Agency Standing Committee (IASC) coordination mechanisms to better respond to health crises.

iv. Cross-cutting issues (see recommendations 10 to 25)

a. Development and health

While new and dangerous pathogens can emerge in any country in the world, poor living conditions mean that developing countries are particularly vulnerable to the impact of communicable disease outbreaks. Inadequate sanitation can accelerate disease spread, and weak health systems undermine the capacities to respond.
The Panel urges all Member States to achieve the Sustainable Development Goals (SDGs), particularly in the area of health. It notes that the threat of health crises from communicable diseases has been recognized in Goal 3.3 and urges Member States to ensure that the SDG monitoring and follow-up process takes into account compliance with IHR Core Capacity requirements as a crucial element in preventing outbreaks of communicable diseases. The Panel further recommends that the WHO work closely with development actors to ensure complementarity between development programmes and efforts to build health care systems and public health.

b. Research and development

The availability of effective medical countermeasures, including vaccines, therapeutics and diagnostics, is crucial in preventing and responding to communicable disease outbreaks.
However, investment in medical R&D for diseases that largely affect the poor is deeply inadequate. Of the $214 billion invested in health R&D globally in 2010, less than 2 per cent was allocated to neglected diseases (ND). Even where vaccines or therapeutics exist, they are often inaccessible or unaffordable to vulnerable populations.

Public policy intervention, including more public funding, is required to ensure greater resources are focused on R&D for NDs and other dangerous pathogens, particularly in developing countries. The Panel therefore recommends that the WHO oversee the establishment of a fund to support R&D of vaccines, therapeutics and diagnostics for neglected communicable diseases. R&D efforts should be targeted according to a priority list of pathogens developed by the WHO. In addition, the Panel notes that additional measures should be taken to support access to and affordability of medicines for all.

c. Finance and economic measures

Building a more effective global health architecture that is better prepared to respond to health crises will require additional financial resources. In the view of the Panel, investments will be needed in three key areas. First, there is a need to mobilize domestic and international funding to support the implementation of the IHR’s Core Capacity requirements. Least Developed Countries and other vulnerable countries should receive assistance from partners in this regard. Second, equipping the WHO with an effective operational preparedness and emergency response capacity will require a 10 per cent increase in the organization’s assessed funding, as well as the provision of adequate contingency funds for emergencies. Third, at least $1 billion per annum is needed to support the R&D fund for medical counter-measures for pathogens that pose a high risk of health crises. More strategic coordination of existing resources and new funding to support these priorities can increase effectiveness and result in a safer world.

The Panel further notes that the trade and travel restrictions imposed during outbreaks often result in significant economic losses for the affected countries and the globe. They also act as a disincentive for governments to report in a timely manner, and can hinder the response effort. As a result, the Panel recommends that measures be identified to minimize their use.

v. Follow-up and implementation (see recommendations 26 & 27)

Inadequate political leadership at the country, regional and international levels in preparing for and responding to health crises can undermine effective and timely responses. In the view of the Panel, heads of state and government must initiate early and decisive actions relating to pandemics.
Moreover, previous attempts to reform the global health architecture have stalled or failed because of lack of political support.

The Panel is convinced that a high-level political mechanism is needed to maintain current momentum, ensure the implementation of crucial reforms, and to support the organisation of a Summit on Global Public Health Crises. The Panel therefore proposes the creation of a High-level Council on Global Public Health Crises.

E. Conclusion

The Panel believes that, if implemented, its recommendations will serve to strengthen the global health architecture under the leadership of the WHO. By building on existing mechanisms, the Panel’s recommendations will strengthen global capacity to monitor risks, detect outbreaks early, and rapidly deploy a fully resourced, effective response. In addition, the Panel’s proposals to dedicate resources to R&D on prioritized pathogens will ensure the greater availability of critical vaccines and treatments when they are most needed.

BENIN

12 DEAD IN LASSA FEVER OUTBREAK

As of 5 February, 25 suspected cases of Lassa fever including 12 deaths had been reported in the country. The disease was first detected on 5 January following the death of a patient at a hospital in the central Tchaourou locality. Among other prevention measures, the Government and health partners are registering contacts, have set up isolations units and are stocking up on medication and equipment.

CENTRAL AFRICAN REPUBLIC

US$ 9 MILLION FOR URGENT NEEDS RELEASED

The country-based Common Humanitarian Fund (CHF) has allocated US$ 9 million for life-saving assistance to internally displaced people (IDPs), returnees, refugees and vulnerable host communities. The funds will support projects responding to urgent needs such as improving access of affected populations to basic services and contribute to reducing violence in and among communities. Projects that include knowledge transfer to national NGOs will be prioritized.

TOGO

MENINGITIS OUTBREAK KILLS 13 IN NORTHERN REGION

In a meningitis outbreak in the northern Kara region 162 cases were reported as of 6 February, killing 13 people. Medical treatment and sensitization on preventive measures are underway, as a vaccination drive is awaited.

CHAD

OVER 56,000 NEWLY IDENTIFIED IDPs

More than 56,000 IDPs have been newly identified in 22 different sites in Liwa and Daboua districts in the north of the Lac region. According to a recent inter-cluster assessment, the majority of IDPs settled in the areas in November 2015 after fleeing their homes on Lake Chad islands near the Niger border. Other IDPs were already displaced in June and July 2015 due to Boko Haram attacks as well as large scale military operations. The displaced families so far have received little to no assistance, and humanitarian partners are looking into covering their most urgent needs.

EBOLA VIRUS DISEASE

MOST CONTACTS LEAVE QUARANTINE IN SIERRA LEONE

No new Ebola cases were reported in the week ending 7 February. As of 3 February, only four contacts arising from the mid-January flare-up in Tonkolili district remained in quarantine. In Kambia district, efforts at the chiefdom level to trace missing contacts and search for any missed cases are ongoing.

BÉNIN

12 MORTS DANS L’ÉPIDÉMIE DE FIÈVRE DE LASSA

Au 5 février, 25 cas suspects de fièvre de Lassa, dont 12 décès, avaient été signalés dans le pays. La maladie a été détectée pour la première fois le 5 janvier suite à la mort d'un patient dans un hôpital de la localité centrale de Tchaourou. Parmi les mesures de prévention, le gouvernement et les partenaires de la santé procèdent à l'enregistrement des contacts, la mise en place d’unités d’isolation et le stockage de médicaments et d'équipements.

RÉPUBLIQUE CENTRAFRICAINE

9 MILLIONS $US DÉBLOQUÉS POUR LES BESOINS URGENTS

Le Fonds humanitaire commun au niveau du pays (CHF) a alloué 9 millions $US pour une aide vitale aux personnes déplacées internes (PDI), aux rapatriés, réfugiés et aux communautés d'accueil vulnérables.

Les fonds serviront à soutenir des projets qui répondent à des besoins urgents tels que l'amélioration de l'accès des populations affectées aux services de base et contribueront à réduire la violence dans et entre les communautés. Les projets comprenant le transfert des connaissances aux ONG nationales seront priorisés.

TOGO

UNE ÉPIDÉMIE DE MÉNINGITE TUE 13 PERSONNES

Une épidémie de méningite dans la région nord de Kara a tué 13 personnes, avec 162 cas signalés en date du 6 février. Le traitement médical et la sensibilisation sur les mesures préventives sont en cours, en attendant une campagne de vaccination.

TCHAD

PLUS DE 56 000 PDI IDENTIFIÉES

Plus de 56 000 personnes déplacées internes (PDI) ont été récemment identifiées vivant dans 22 sites du nord de la région du Lac, dans les districts de Liwa et Daboua. Selon une récente évaluation inter-cluster, la majorité des PDI est installée dans la zone depuis novembre 2015, après avoir fui les îles du lac Tchad, près de la frontière du Niger. D'autres PDI sont déplacées depuis juin et juillet 2015 en raison des attaques de Boko Haram et des opérations militaires de grande envergure. Les personnes déplacées ont reçu, jusqu’à présent, peu ou pas d'aide. Les partenaires humanitaires travaillent à satisfaire leurs besoins les plus urgents.

MALADIE À VIRUS EBOLA

LA PLUPART DES CONTACTS SORTIS DE QUARANTAINE EN SIERRA LEONE

Aucun nouveau cas n’a été signalé dans la semaine se terminant le 7 février. En date du 3 février, seuls quatre contacts liés aux nouveaux cas de mi-janvier dans le district de Tonkolili restent en quarantaine. Dans le district de Kambia, les efforts sont en cours au niveau de la chefferie pour retracer les contacts manquants et rechercher tous les cas

Introduction 



Introduction 

The largest Ebola outbreak in history started in Guinea in December 2013, spread to Liberia by March 2015 and into Sierra Leone by May 2015. The World Health Organization (WHO) declared the outbreak a public health emergency of international concern in August 2014. Sierra Leone, Liberia and Guinea had not experienced an Ebola outbreak before and so understanding of prevention measures and trust in public information was extremely low.

The Ebola Virus Disease (EVD) is spread from the animal population to humans through interaction with wild animals and consumption on bushmeat infected with the virus. Human to human transmission routes are through contact with a person's bodily fluids once they are symptomatic or if they have died from Ebola. Ebola symptoms are initially very similar to those of other illnesses such as malaria, typhoid, cholera and flu, starting with fever, headache, diarrhoea and vomiting. At the time, there was no vaccine available, and there is no cure for Ebola.



The President of the International Federation of Red Cross and Red Crescent Societies (IFRC), Mr Tadateru Konoé, has ended his first visit to Ebola-affected countries with a commitment from the Government of Guinea to integrate trained Red Cross volunteers into recovery efforts, and a promise from the Government of Sierra Leone to consider doing the same.

“More than 5,000 Red Cross volunteers in Guinea and Sierra Leone were trained during the Ebola response, many of them in infection, prevention and control,” said President Konoé. “They gained valuable experience and skills which can be used in not only responding to various disease outbreaks, but in also acting as early warning systems. I strongly believe that these volunteers can, and should, play a key role in the rebuilding of community-based health systems.”

While in Guinea, the IFRC President advocated on integrating trained Red Cross volunteers into Ebola recovery efforts when he met with several government officials including Head of State, His Excellency, President Alpha Condé, and Minister of Health, Mr Abdouraman Diallo. “We are very familiar with seeing the Red Cross as being the first to respond,” said Mr Diallo. “You have our support to ensure trained volunteers do not get lost in their communities but are used to help build resiliency.” In Sierra Leone, President Konoé discussed similar opportunities with Minister of Foreign Affairs and International Cooperation, His Excellency, Dr Samura M.W. Kamara.

“Ebola taught us the importance of investing in community-based surveillance, and early warning and response mechanisms so diseases are identified before they become full blown epidemics,” added Konoé. “But we need to go further. When public health emergencies threaten and do cross international borders, such as Ebola, and now the Zika virus in the Americas, it is vital that we share these experiences and knowledge to ensure more effective and efficient responses.”

As part of their recovery operations, the Red Cross Society of Guinea and the Sierra Leone Red Cross Society, with the support of the IFRC, are working with trained volunteers to teach additional community members how to conduct surveillance and identify symptoms of disease when they first surface. By alerting authorities and allowing the implementation of rapid response systems, an outbreak can potentially be stopped before it starts.

“I cannot emphasize enough the key role of Red Cross volunteers in the fight against Ebola, particularly in the provision of safe and dignified burials,” said President Konoé. “The outbreak would not be over in Guinea, and down to minimal cases in Sierra Leone, if not for their heroic actions. Engaging these trained volunteers in strengthening community resilience is a logical next step as these countries begin to recover from this deadly outbreak.”

The IFRC President made it a priority to meet with both volunteers and community members during his visit. In Guinea, a boisterous crowd of hundreds of volunteers dressed in white greeted President Konoé as he arrived in Kobaya to inaugurate a new first aid training centre. In Sierra Leone, he travelled to Waterloo, an Ebola-affected community just outside the capital Freetown where he met a young Ebola survivor, toured a village for a first hand look at disaster risk reduction efforts they have implemented, and later met with volunteers at the Western Area branch where he was made an honourary member.

Freetown, Sierra Leone | AFP | Thursday 2/11/2016 - 18:01 GMT

Four people who had been in contact with Sierra Leone's last known Ebola case were declared free of the disease and released from quarantine Thursday, health authorities said.

The authorities announced on Tuesday that the Ebola patient, 38-year-old Memunatu Kalokoh, was cured and discharged from hospital.

She was the primary carer of Marie Jalloh, who died of the disease on January 12 in the northern town of Magburaka.

Four contacts who had been residing in the same quarantine zone as Kalokoh when she became ill were placed under observation.

"The four, all women, were quarantined because they were residing in the same compound with the aunt of the index case involving 22-years-old Marie Jalloh, who was diagnosed positive and later died from Ebola in January", Foday Dafai, director of disease prevention and control at the health ministry, told AFP.

"All of them were tested before they were released and they showed no signs and symptoms of the virus. With their release, nobody is in quarantine nor admitted in any hospital for Ebola".

Sierra Leone was declared free of Ebola transmission on November 7 last year and Guinea on December 29 while Liberia followed on January 14 -- but only after the virus killed more than 11,300 people, according to the World Health Organization (WHO) estimations, triggering a global health alert.

The WHO has been warning of the possibility of a recurrence and stressing the importance of a quick, effective response to potential new cases

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About this report: DTM in the Mediterranean and beyond

While populations from the Middle East, South East Asia, and Africa have been crossing the Mediterranean to reach Europe in growing numbers since 2011, 2015 marked the sharpest increase arrivals to Europe and deaths in the Mediterranean. International organizations and EU policy makers recognized the urgent need to identify effective measures to tackle the resulting humanitarian issues, but at the start of the crisis, relatively little was known about migrants arriving to Europe beyond their nationality, sex, and age. Thus, IOM rolled out its Displacement Tracking Matrix (DTM) across the affected region. DTM is a suite of tools and methodologies designed to track and analyse human mobility in different displacement contexts, in a continuous manner. Through DTM’s flow monitoring system, over the course of 2015 IOM identified key locations along the migratory route to collect data through direct observation, consultations with relevant national authorities, and surveys with migrants. The transit point assessments provide information on numbers of migrants, countries of origin, demographics, routes, and transport, using data provided by ministries of interior, coast guards, police forces, and other relevant national authorities. The flow monitoring surveys provide more in-depth information on specific vulnerabilities, socioeconomic circumstances, routes, reasons for movement, and country of intended destination. IOM field staff started conducting these interviews in October, starting in Croatia and also covering Greece, the former Yugoslav Republic of Macedonia (fYROM), and Slovenia. As of 31 December 2015 IOM had interviewed over 1,673 migrants and asylum seekers.

These activities allow IOM to systematically gather detailed information about migrants’ backgrounds, motivations, and the migratory routes, and to share ongoing analyses of migratory trends and patterns with humanitarian actors and policy makers. Such information is key to devising appropriate and effective measures to manage migration, including protection for those who are entitled to it, possible integration for those who can stay in the EU and more sustainable return and reintegration to the countries of origin. This report is an overview of the year, based on IOM’s weekly flows compilations.

• As we enter February 2016, GPEI bids farewell to Hamid Jafari, the former director of GPEI, whose tenure has seen the removal of Nigeria from the list of polio-endemic countries, certification of the eradication of wild poliovirus type 2, and the lowest number of cases reported in the fewest number of places in any one year. GPEI welcomes Michel Zaffran, former coordinator of the WHO Expanded Programme on Immunization (EPI), as its new director, as we enter a pivotal part of the Endgame Plan.

• Iraq has introduced the inactivated poliovirus vaccine (IPV) into its routine immunization system. Read more here.

• Environmental surveillance is playing an increasingly important role in ensuring that the poliovirus is found, wherever it continues to circulate. Find out more about environmental surveillance through this series of photographs.

• There are nine weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, an important milestone in achieving a polio-free world. Read more here.

Key messages

• At the height of the Ebola crisis in West Africa, the acute shortage of trained medical teams ready for deployment for health emergency response became an apparent gap in the international response.

• As a direct follow up, the European Union has set up a European Medical Corps (EMC) through which teams and equipment from the EU Member States can be rapidly deployed to provide medical assistance and public health expertise in response to emergencies inside and outside the EU.

• The EMC is part of the existing European Emergency Response Capacity (also known as voluntary pool), established under the EU Civil Protection Mechanism (EUCPM).

• To be part of the EMC, the teams need to undergo a certification process to make sure that they meet the strict quality criteria and that they are trained to work within the international coordination framework. In return they benefit from EU financial support.

• By January 2016, nine Member States have already offered teams and equipment to the European Medical Corps (BE, LU, ES, DE, CZ, FR, NL, FI, SE).

The West-African Ebola outbreak of 2014 and 2015 is almost over. Fortunately, people in Sierra Leone, Liberia and Guinea are able to look towards a new future. With investments in healthcare, sexual and reproductive rights and small- to medium-scale entrepreneurship, Cordaid supports Sierra Leoneans in rebuilding their country.

This week, Cordaid CEO travels to Sierra Leone with journalists and photographers, to show them which results were obtained in the Cordaid response to the Ebola crisis. The Dutch national appeal ‘Stop Ebola’ resulted in over 10 million euros of public donations. Cordaid spent part of that money through our PBF-Plus health systems strengthening program, and with success.

En bref

• Le 18 janvier, l’OIM a participé à une rencontre avec les Ministères de la Santé, les partenaires de la Riposte et les autorités locales de Guinée et de Sierra Leone à Pamelap, à la frontière, afin de partager les dernières informations sur les cas de MVE en Sierra Leone

• Du 25 au 29 janvier, l’OIM, en partenariat avec le CDC et la George Washington University, a assuré une formation en Gestion d’Urgence Sanitaire (GUS) à 11 formateurs, cadres nationaux de santé.

• Le 28 janvier, le Chef de mission de l’OIM Guinée, M. Amihere Kabla, a accompagné la délégation Pays du Système des Nations Unies à la Primature pour féliciter le nouveau Premier Ministre, M. Mamady Youla, pour sa nomination et lui présenter ses vœux.

Situation de la maladie à Virus Ebola après sa résurgence en Sierra Leone

Le 20 janvier, un deuxième cas de maladie à virus Ebola (MVE) a été confirmé en Sierra Léone. Il s’agit de la tante de la jeune fille décédée le 12 janvier dans le district de Tonkolili, dans le nord du pays, et dont les analyses post-mortem avaient confirmé qu’elle était morte de la MVE.

Depuis la confirmation de la réapparition de la maladie à virus Ebola en Sierra Leone le 14 janvier dernier, le Gouvernement Guinéen a aussitôt émis le souhait de renforcer les activités de surveillance sanitaire au niveau des points d’entrée frontaliers (PE) avec la Sierra Léone. Il a demandé à l’OIM et ses partenaires de relancer les points de contrôle sanitaires aux principaux points d’entrée du pays.

L’organisation a pour sa part réactivé les contrôles sanitaires au niveau de 48 points d’entrée (PE) officiels et non officiels établis le long de la frontière avec la Sierra Leone, dans les Préfectures de Forécariah et de Kindia.

Bien qu’aucun cas suspect n’a été signalé en Guinée depuis la déclaration officielle de la fin de l’épidémie le 29 décembre 2015 par l’OMS, la vigilance reste de mise dans tout le pays.

• On 18 January, IOM took part to a crossborder meeting in Pamelap with the Minister of Health, the National Coordination, as well as EVD Response partners in Guinea and Sierra Leone, to share all information related to the EVD cases in Sierra Leone.

• From January 25 to 29, in partnership with CDC and the George Washington University, IOM organized a training of trainer session in Health Emergency Management (HEM) to 11 beneficiaries

• On 28 January, the Chief of Mission of IOM Guinea, along with UNCT delegation, congratulated the newly appointed Prime Minister, Head of Government, Mr. Mamadi Youla, for his nomination and addressed him their wishes.

Situation of the Ebola Virus Disease after its resurgence in Sierra Leone

On January 20, a second Ebola Virus Disease (EVD) case was confirmed in Sierra Leone. It concerned the aunt of the young lady who died on January 12 in the district of Tonkolili, in the northern part of the country and that post-mortem analysis confirmed that she died of EVD.

After the Ebola Virus Disease reappeared in Sierra Leone on January 14, Guinean authorities decided to strengthen health surveillance activities at the country’s borders with Sierra Leone. IOM remains a key partner in implementing these activities.

OIM re-launched health screening activities at the 48 official and non-official Points of Entry along the border in Forecariah and Kindia (Madina Oula).

No new case has been reported in Guinea since the official end of the epidemic was declared by WHO.

I. Introduction

1. The present report has been prepared pursuant to General Assembly resolution 60/180 and Security Council resolution 1645 (2005), in which the Peacebuilding Commission was requested to submit an annual report to the Assembly for an annual debate and review. The report will also be submitted to the Council, pursuant to its resolution 1646 (2005), for an annual debate. The report covers the ninth session of the Commission, held from 1 January to 31 December 2015.

2. On 29 October 2010, the General Assembly and the Security Council adopted resolutions 65/7 and 1947 (2010), respectively, through which the two organs, inter alia, requested the Commission to reflect, in its annual reports, the progress made in taking forward the relevant recommendations contained in the report of the co-facilitators on the review of the United Nations peacebuilding architecture (A/64/868-S/2010/393, annex). Beginning with the report of the Commission on its sixth session, the implementation of relevant recommendations from the 2010 review has been mainstreamed into the reporting on the Commission’s policy and country-specific activities. The structure of the three previous reports reflected this development in content and format, placing added emphasis on performance of the main functions in the specific country settings, the role of the membership, the links with parent organs and the themes explored by the Commission.

3. Furthermore, each of the previous three reports included a forward agenda to guide the work of the Commission on country-specific and policy-related engagements in the session following that covered by the report. In order to strengthen the framework within which the Commission conducts its activities, the present report is structured around the elements contained in the forward agenda of the annual report on the eighth session (see A/69/818-S/2015/174, paras. 66-72). The present report will also touch upon the 2015 review of the United Nations peacebuilding architecture and how the Commission has engaged with the recommendations contained therein.

As the emergency phase of the response to the Ebola outbreak winds down in Guinea, Liberia and Sierra Leone, the 3 countries face an equally urgent and formidable task: building health systems capable of preventing, detecting and responding to outbreaks.

When Ebola first started spreading in West Africa, the early-warning systems that should have sounded the alarm bell failed to detect the outbreak until it was too late. That allowed the virus to spread rapidly, unhindered by fragile health systems that collapsed under its onslaught.

In Sierra Leone, that early-warning system, called Integrated Disease Surveillance and Response (IDSR), had existed since 2003, but was essentially dormant when Ebola hit. WHO worked with the government to revive it, adapt it for Ebola, and trained health workers across the country to use it. The effectiveness of that system in identifying and responding to cases sooner was a crucial step in helping to blunt the outbreak.

Now WHO is assisting Sierra Leone’s government to expand the system to track 26 priority diseases, including cholera, measles, malaria, typhoid fever as well as women who die in childbirth.

"It's not just about collecting data but making sure there's a response capacity, so we've worked with districts to make sure there is," said Anders Nordstrom, WHO Representative in Sierra Leone.

Saving lives

While Ebola killed almost 4000 people in Sierra Leone, about 26 000 children die every year of other causes such as malaria and measles. Expanded IDSR can help save those lives. The system works by training community health workers in all 14 districts to identify and report early symptoms of the 26 diseases, or rumours of outbreaks. Those reports are fed to the nearest public health unit, which dispatches a team to investigate.

It’s already paying dividends. On 11 January 2016, the system flagged a sudden increase of watery diarhoea and vomiting in Kania, a remote village in Kambia district near the border with Guinea. Within 8 hours, a team of investigators from WHO, the Ministry of Health and the United Nations Children’s Fund was on site, making sure infection prevention measures were in place to help prevent further cases.

"We were terrified thinking we had tripped back into the hands of Ebola since the people were vomiting and had diarrhoea, all typical of the deadly disease," said Mr Amadu Kamara, chief of the Kania village. Further investigation including water testing to establish the cause of the sickness and rule out cholera are underway.

The IDSR training was critical to ensure prompt reporting. "It is good that we now have the IDSR system in place to serve as a major trigger for prevention and response," said Dr Foday Sesay, Kambia’s District Medical Officer. "The ongoing investigation of the suspected cases, planning and preparedness that are happening were triggered because our health workers at the facility level were able to detect an unusual event, which if they had missed could have derailed our health gains," Dr Sesay said.

Responding to measles

The IDSR system has also recently been instrumental in identifying and responding to an increasing number of measles cases that have arisen because of a breakdown in routine vaccination services during the Ebola outbreak. The next step is to develop the capacity for community-based reporting via mobile phone, Dr Nordstrom said.

More than 70% of clinics and hospitals are now reporting on time on all 26 diseases. The system is now being used to track maternal mortality, for which Sierra Leone has the world’s highest rate and where under-reporting has historically been the norm. Almost 3000 women die during childbirth every year, or about 50 a week. About 4 deaths a week are currently being reported through the IDSR system. While there is work to do to close that gap, it’s a vast improvement on the system that existed before Ebola, and which only concentrated on communicable diseases. Knowing where and why women are dying is key to taking the right steps to keep them alive and healthy.

"We’re using the infrastructure built for Ebola to help Sierra Leone and the world become safer," Dr Nordstrom said.

Toward a safer and healthier future

WHO is working with the government to strengthen other parts of the health system, including bolstering the capacity of government laboratories to detect the 10 diseases most likely to cause epidemics, and equipping 4 laboratories capable of handling high-risk samples.

Much work remains to be done, and Sierra Leone’s health system continues to face significant challenges. But in a country that lost 12 of its 220 doctors to Ebola, there are signs of progress toward a safer and healthier future.

Country Strategy

In Sierra Leone, WFP supported the response to ebola through regional operations (EMOP 200761 and SO 200773) which came to a close on 31 December 2015. The operations focused on supporting Sierra Leone get to ‘zero’ Ebola Virus Disease (EVD) cases and maintain a resilient zero. Food and nutrition support was provided to affected families and communities in Sierra Leone, Guinea and Liberia, under the care, contain and protect pillars. Logistics assistance, supply chain management, engineering, emergency telecommunications, and humanitarian air services were provided across the three affected countries to support the overall humanitarian response. WFP also runs a Country Programme (CP 200336), which has school feeding, nutrition and food/cash-for assets components.
WFP has been present in Sierra Leone since 1968.

Summary of WFP assistance

WFP’s Emergency Operation (EMOP 200761) focused on supporting the medical response to stop the spread of EVD by meeting the basic food and nutrition needs of affected families and communities in Sierra Leone. WFP provides food assistance to care for patients and their caretakers in treatment centres and to survivors upon discharge, to contain the spread of the virus in hotspot communities and quarantined households and to protect households in areas most affected by the virus as well as Ebola driven vulnerable groups.

Alongside the EMOP, WFP managed the regional Special Operation (SO 200773), enabling the global response of the humanitarian community by providing logistics support, supply chain, infrastructure development, emergency telecommunications, and humanitarian air services across Guinea, Liberia and Sierra Leone.

While most of the Country Programme has been on hold due to the Ebola outbreak and subsequent risks of EVD transmission in group settings, WFP continued to provide food assistance to patients living with HIV. In the final quarter of 2015, WFP resumed a targeted supplementary feeding programme (TSFP) to provide treatment for moderate acute malnutrition (MAM) in children age 6-59 months and pregnant and nursing mothers under its Country Programme (CP200336).