Summary:
In March 2014 an outbreak of Ebola virus disease (EVD) was detected in Guinea close to the borders of Sierra Leone and Liberia. At that time, the Sierra Leone Ministry of Health and Sanitation established a National Ebola Taskforce to coordinate activities to prevent and prepare for the detection of EVD in the country.
Following the confirmation of cases in Guinea on 28 March 2014 the IFRC allocated CHF 113,217 from its Disaster Relief Emergency Fund (DREF) for Ebola preparedness activities in Sierra Leone. A report on the progress achieved under the DREF money can be accessed here. Following the confirmation of cases within the border of Sierra Leone the DREF allocation was converted into a start-up loan for the Emergency Appeal operation launched on 26 June 2014. On 26 May, the Ministry of Health and Sanitation announced that the first case of EVD had been detected in Sierra Leone. Soon after, a further seven cases were identified. All of these early cases resided in the Kissi Teng Chiefdom which forms the easternmost part of Kailahun District. All eight persons had attended the funeral of a traditional healer in Guinea.
Until the outbreak, the IFRC did not have representation in the country and had been supporting Sierra Leone Red Cross Society (SLRCS) through its regional office for West Africa in Cote d’Ivoire. Currently IFRC has a coordination hub in Accra, Ghana which is coordinating the whole response in the affected countries. Before the confirmation of cases in Sierra Leone, regional staff were deployed to support the SLRCS in preparedness activities. As the situation deteriorated and the National Society initiated response to active cases, an IFRC Field Assessment and Coordination Team (FACT) was deployed and arrived in Freetown in early June, followed by staff from the Basic Health Care ERU and IT/Telecomm Emergency Response Units.
IFRC initially set up a base in Kailahun and now has ETCs in Kenema and Kono and a main operation centre located in Freetown. IFRC Delegates are supporting SLRC branch activities in Port Loko, Bombali and Koinadugu. As part of the scaling up process, IFRC is supporting the NS in implementing activities outlined in all the pillars in all districts across the country. Safe and Dignified Burial teams have been trained and are operational in all districts carrying out 400 – 450 safe and dignified burials per week by end 2014. Contact tracing activities are carried out in coordination with MoHS and other partners and Red Cross is becoming increasingly more involved in surveillance. Psychosocial support (PSS) is offered through visits to families living in quarantined homes, the distribution of survivor kits and interventions with staff and volunteers. Social mobilization and beneficiary communications activities are being implemented at the community level through traditional methods including distribution of IEC material and, increasingly, by using beneficiary communications methods. Clinical management is offered through the IFRC 60 bed Ebola Treatment Centre in Kenema which opened in September 2014 and the ETC in Kono will open in January 2015 with 30 beds.
As the cases load soared and spread across all the districts in the country, IFRC revised the Emergency Appeal in 18 July and further revisions were made 9 September and again on 22 October increasing the operational budget to CHF 41 Million to support the revised strategy by the Red Cross response ramping up Surveillance and Contact Tracing, Safe and Dignified Burials, Social Mobilisation and Psychosocial Support from an initial 6 districts to all 14 districts.
By year-end, incidence of Ebola virus disease in Sierra Leone continued to remain very high and spreading with cases reported in all districts. The epidemic has been particularly bad in Western Area (Urban) which refers to the capital Freetown, Western Area Rural, Port Loko, Bombali and Kono. Hotspots erupt with frequency aided by population movement across the country aided to a great degree by an extensive road network. Transmission elsewhere such as in Bonthe, Pujehun, Kailahun and Kenema is relatively stable but care is required to ensure surveillance systems are in place to quickly detect and deal with suspected cases.
Difficulties in accessing communities to track potential contacts, alongside insufficient infrastructure to deal with the rapidly increasing caseload, make it difficult to ascertain precisely the evolution of the outbreak. The number of reported cases and deaths, contacts under medical observation and the number of laboratory results are in constant flux.