The worst outbreak of Ebola virus disease (EVD) in history continues to ravage communities in West Africa. UNICEF estimates that 9.8 million children and young people under the age of 20 live in Guinea, Sierra Leone and Liberia; countries where disease transmission is widespread and intense. Of these, 2.9 million are under the age of 5. UNICEF estimates that up to 10,000 children have lost one or both parents or caregivers due to Ebola. There is a risk of the virus spreading to the neighboring countries of Benin, Burkina Faso, Cameroon, Central African Republic, Côte d’Ivoire, Gambia, Ghana, Guinea Bissau, and Togo which are considered at risk. In addition, Nigeria and Senegal have already had outbreaks but became “Ebola free”. In Mali, a total of 8 confirmed and probable cases and 7 deaths have been reported as of 30 November 2014.
The rapid spread of Ebola in West Africa has been exacerbated by weak health systems and poor hygiene and sanitation practices. In particular, unsafe burial practices and lack of early isolation and care have driven rapid transmission. In addition, the lack of functioning surveillance systems to screen and trace those who have been in contact with infected persons within countries and across borders has made the outbreak more difficult to control. The fact that the number of health facilities able to isolate and treat cases is still inadequate has also contributed to the widespread and persistent transmission. Ebola is a new disease in the region and for the affected communities. Many local health workers that responded to the outbreak initially did so without the knowledge and the capacity required, putting themselves and the patients at risk.
National governments, in partnership with the UN, international and national non-governmental organizations (NGOs) have been responding to the Ebola outbreak since March 2014. In August 2014, the World Health Organization (WHO) declared the Ebola outbreak a ‘Public Health Emergency of International Concern’. In order to further strengthen the national efforts to stop the outbreak and provide treatment to affected populations, a UN Mission for Ebola Emergency Response (UNMEER) has been established. With the aim of prioritizing actions to stop the transmission of the disease, UNMEER has allocated responsibility for the clinical care and monitoring of EVD patient numbers to WHO, and for community engagement including community care centres and social mobilization/behaviour change to UNICEF. The IFRC has taken on the responsibility for ensuring safe funeral practices and burial.
UNICEF preparedness and response strategy
UNICEF has developed an Ebola Regional Response Strategy in-line with the UN inter-agency strategic framework for Ebola response known as STEPP: STOP the outbreak, TREAT the infected, ENSURE essential services, PRESERVE stability, and PREVENT outbreaks in countries currently unaffected. Further refinement of the strategy and prioritization of UNICEF activities took place following the establishment of UNMEER. UNICEF has three goals: first, to stop the outbreak through actions at community level; second, to prepare for outbreaks in additional countries; and third, to contribute to maintaining or building back better of the primary health care and other social systems in the most affected countries.
In the period through June 2015, UNICEF, as a critical UN partner in the UNMEER-led Ebola response, has three specific objectives: first UNICEF aims to bring the outbreak under control through contributing significantly to system-wide goals of 100 per cent early isolation and 100 per cent safe burial in each of the affected countries. Second, UNICEF aims to prevent other high risk countries suffering major outbreaks during this period. Finally, UNICEF aims to support early recovery and the initiation of building back better primary health care systems and other social services. It is important to note that the Ebola outbreak has posed unique challenges to all agencies, including UNICEF. Strategies had to be adjusted and refined and new public health solutions introduced at the community level.
Key results for stopping the outbreak will include: the training and deployment of around 60,000 community volunteers; measurably improved practices for safe burial and early isolation; up to 300 Community Care Centres (CCCs) or variants, including transit centres, observation centres and rapid isolation facilities, made safe or constructed and staffed as needed; up to 10,000 children whose parents or caregivers have died due to Ebola supported with child and social protection services; and stock outs of Personal Protective Equipment (PPE) and other critical Ebola-related commodities prevented.